Sample records for olecranon fractures one-third

  1. Adult Monteggia and Olecranon Fracture Dislocations of the Elbow. (United States)

    Wong, Justin C; Getz, Charles L; Abboud, Joseph A


    Monteggia fractures and olecranon fracture dislocations represent complex injuries with distinct patterns of bony and soft tissue involvement. Fractures of the proximal ulna and olecranon process may lead to disruption of the proximal radioulnar joint and/or ulnohumeral joint. The keys to treatment are recognition of the pattern of injury and formation of an algorithmic surgical plan to address all components of the injury process. Complications are common and may be related to the injury spectrum itself and/or inadequate fracture alignment or fixation.

  2. Risk of hip fracture after osteoporosis fractures. 451 women with fracture of lumbar spine, olecranon, knee or ankle

    DEFF Research Database (Denmark)

    Lauritzen, J B; Lund, B


    In a follow-up study during 1976-1984, the risk of a subsequent hip fracture was investigated in women aged 60-99 years, hospitalized for the following fractures: lumbar spine (n 70), olecranon (n 52), knee (n 129) and ankle (n 200). Follow-up ranged from 0 to 9 years. Observation time of the 4...... different fractures were 241, 180, 469, and 779, person-years, respectively. In women aged 60-79 years with one of the following fractures the relative risk of a subsequent hip fracture was increased by 4.8 (lumbar spine), 4.1 (olecranon), 3.5 (knee) and 1.5 (ankle). The relative risk of hip fracture showed...

  3. Repair of olecranon fractures using fiberWire without metallic implants: report of two cases

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    Okawa Atsushi


    Full Text Available Abstract Olecranon fractures are a common injury in fractures. The tension band technique for olecranon fractures yields good clinical outcomes; however, it is associated with significant complications. In many patients, implants irritate overlying soft tissues and cause pain. This is mostly due to protrusion of the proximal ends of the K-wires or by the twisted knots of the metal wire tension band. Below we described 2 cases of olecranon fractures treated with a unique technique using FiberWire without any metallic implants. Technically, the fragment was reduced, and two K-wires were inserted from the dorsal cortex of the distal segment to the tip of the olecranon. K-wire was exchanged for a suture retriever, and 2 strands of FiberWire were retrieved twice. Each of the two FiberWires was manually tensioned and knotted on the posterior surface of the olecranon. Bony unions could be achieved, and patients had no complaint of pain and skin irritation. There was only a small loss of flexion and extension in comparison with that of the contralateral side, and the patient did not feel inconvenienced in his daily life. Using the method described, difficulty due to K-wire or other metallic implants was avoided.

  4. Repair of olecranon fractures using fiberWire without metallic implants: report of two cases (United States)


    Olecranon fractures are a common injury in fractures. The tension band technique for olecranon fractures yields good clinical outcomes; however, it is associated with significant complications. In many patients, implants irritate overlying soft tissues and cause pain. This is mostly due to protrusion of the proximal ends of the K-wires or by the twisted knots of the metal wire tension band. Below we described 2 cases of olecranon fractures treated with a unique technique using FiberWire without any metallic implants. Technically, the fragment was reduced, and two K-wires were inserted from the dorsal cortex of the distal segment to the tip of the olecranon. K-wire was exchanged for a suture retriever, and 2 strands of FiberWire were retrieved twice. Each of the two FiberWires was manually tensioned and knotted on the posterior surface of the olecranon. Bony unions could be achieved, and patients had no complaint of pain and skin irritation. There was only a small loss of flexion and extension in comparison with that of the contralateral side, and the patient did not feel inconvenienced in his daily life. Using the method described, difficulty due to K-wire or other metallic implants was avoided. PMID:20937160

  5. Complications and re-operation rate after tension-band wiring of olecranon fractures

    DEFF Research Database (Denmark)

    Romero, J M; Miran, A; Jensen, Claus Hjorth


    Tension-band wire fixation of olecranon fractures leads to a high re-operation rate because of the need to remove the metalware. This problem has commonly been thought to be related mainly to the backing-out of the Kirschner wires. A retrospective study was carried out in 55 patients with displaced...... olecranon fractures operated on with the tension-band wiring technique, in whom there was an overall 71.7% re-operation rate. Complications were few and minor in most patients. The main reason for the removal of the metalware was a direct complaint from the patient (in 61.3% of all removals). A literature...

  6. Clinical evaluation of locking compression plate fixation for comminuted olecranon fractures

    NARCIS (Netherlands)

    Buijze, G.; Kloen, P.


    BACKGROUND: In patients managed with plate fixation for the treatment of an olecranon fracture, the placement of an axial intramedullary screw may obstruct the placement of bicortical screws in the ulnar shaft. To overcome this problem, unicortical screws can be applied with use of a contoured locki

  7. Management of open olecranon fractures using clamp-cum-compressor device

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    Kundu Zile


    Full Text Available Background: Open fractures of olecranon are not a rare occurrence in patients with road traffic accidents particularly motor bike riders who don′t use elbow guards. Definitive treatment has to be delayed in many till the wound heals. The present study was conducted to evaluate the results of open fractures of olecranon using clamp-cum-compressor device. Materials and Methods: Seventeen patients between the ages of 20 and 45 years of open olecranon fractures reported 5-20 days after injury were treated using an indigenous clamp-cum-compressor. All fractures were Mayo type II-A, i.e., displaced, stable and noncomminuted. Four patients had Gustilo-Anderson grade I and 13 had Gustilo-Anderson grade II open fractures. The patients with transverse or short oblique fractures were included in the study. The apparatus was applied under regional anesthesia after thorough washing and debridement of wounds with few loose sutures applied wherever needed. The wounds healed within 2-4 weeks and fractures united within 8-10 weeks. The elbow was mobilized with apparatus still in place. The results were evaluated by MayoElbow performance score. Results: We achieved excellent results in twelve patients, good in four and poor in one patient, who reported late, hooks of the apparatus were cut through the proximal fragment, leading to union of fracture in elongation and restricted elbow movements. Conclusion: The apparatus was found to be quite useful in transverse and short oblique fractures with contamination or infection, where internal fixation has to be delayed or avoided.

  8. Outcomes of the distal intraarticular humeral fractures treated by olecranon osteotomy

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    Erhan Yılmaz


    Full Text Available Objectives: To evaluate the management and outcome of intraarticular fractures of the distal humerus treated by open reduction and internal fixation using the olecranon osteotomy technique. Materials and methods: Twenty-one patients with in-traarticular fractures of the distal humerus were treated by open reduction and internal fixation. The mean age of the patients was 41.6 years and the mean follow-up pe-riod was 25.3 months. All fractures were type C accord-ing to the AO/ASIF fracture classification system. Chev-ron type olecranon osteotomy was performed within 12-24 h after the injury in all cases but 4 of them. Physical and radiological examination of patients with the appro-priate range checks were made.Results: All fractures united within average duration of 3.2 months. Excellent or good results were found in pa-tients less than 50 years-old, in women, when passing time from injury to surgery was within 12 hours and when early mobilization was achieved. The complica-tions were seen as 2 (9.6% transient neuropraxia of the ulnar nerve, 2 (9.6% failure of fixation, 1 (4.8% het-erotopic ossification and 1 (4.8% olecranon non-union. Fracture type (C1 and time from occurrence of injury to surgery (<12 hours are the main prognostic factors for achieving the excellent/ good functional results.Conclusions: The critical factors for a successful out-come of intraarticular fractures of the distal humerus in-cluded meticulous surgical technique, stable internal fix-ation, surgical experimentation and early controlled postoperative mobilization.

  9. Treatment of stress fracture of the olecranon in throwing athletes with internal fixation through a small incision

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    Fujioka Hiroyuki


    Full Text Available Abstract The present study is a report of retrospective case series of stress fracture of the olecranon. Six patients presented posterior elbow pain in throwing in baseball and softball, but fracture was not diagnosed in radiographs. We detected stress fracture of the olecranon using computed tomographic (CT scan and treated the patient with internal fixation with a headless cannulated double threaded screw through a small skin incision. All patients returned to competitive level without elbow complaints after the operation. When throwing athletes present with unusual posterior elbow pain and no significant findings on radiographs, a CT scan examination should be performed. We recommend surgical treatment of internal fixation with a screw through a small skin incision, as a good option for stress fracture of the olecranon in order to allow early return to sports activity in competitive athletes.

  10. Use of Ilizarov Fixator for Grade III B Open Olecranon Fracture: a Case Report and Surgical Technique (United States)

    Sharad Nemade, Pradip; Dash, Kumar Kaushik; Patwardhan, Tanvi Yeshwant; Londhe, Pravin Vasant


    Introduction: External fixator application can be difficult for olecranon fractures in presence of large degloving injuries. We describe use of simple Ilizarov ring fixator construct for grade IIIB open olecranon fracture management. Case Report: A 45-year-old female with Grade III B open comminuted olecranon fracture (30*15cm degloving area) and ulnar nerve palsy was treated with a novel ring fixator construct. Two cut-end olive wires were passed from the proximal olecranon across the fracture site in intramedullary fashion exiting dorsally at mid-ulnar level through healthy skin and were attached to an Ilizarov half ring secured by perpendicular wires. The olive wires were tensioned, achieving compression and stability. Range of motion (ROM) exercises could be started quickly as the elbow was not spanned. Wound healed after skin grafting and at one-year follow-up the patient has good functional results (PRE 7, DASH 9.48), elbow ROM 10°-130°, 75° pronation and 85° supination. The patient returned to pre-injury occupational activities and had no pain. At three-year follow-up, the x-ray and CT showed union of olecranon fragment with well-maintained congruency. Conclusion: Internal fixation in most cases may be precluded by the soft tissue trauma and risk of infection. In addition, the small proximal fragment precludes a stable external fixation. In this technique, the hardware is kept away from the open wound allowing better wound inspection and care. The intramedullary olive wires provide compression and stability, and thus allow early ROM. Ilizarov half-ring and olive wire fixation can be an useful option for management of high grade open olecranon fractures because of its advantages, viz. stable fixation, minimal internal hardware, optimal wound care, immediate initiation of range of motion, and good outcome. PMID:27299012

  11. Acute Compartment Syndrome after an Olecranon Fracture in a Patient with Mild Hemophilia B. (United States)

    Reynolds, John M; Christophersen, Christy; Mulcahey, Mary K


    Compartment syndrome is a serious condition characterized by compartmental pressures within 20 mmHg of diastolic blood pressure, or clinical signs of pain, paresthesia, pallor, and lack of pulses. Often a surgical intervention is necessary. Increased surveillance for compartment syndrome is important when a patient with a bleeding disorder sustains a traumatic injury. We present a case of forearm compartment syndrome in a patient with mild hemophilia B who sustained an olecranon fracture. The patient received factor replacement and he underwent emergent forearm fasciotomies to avoid muscle necrosis. Over the subsequent week, the patient returned to the operating room 3 times for repeat irrigation and debridements, partial wound closure, open reduction internal fixation of his olecranon fracture and eventual skin grafting of the volar forearm wound. Failure to recognize compartment syndrome in even mild forms of hemophilia may result in loss of function, neurologic deficits, and limb amputations. The management of acute compartment syndrome in patients with hemophilia requires timely recognition, replacement of clotting factors, and emergent fasciotomies.

  12. The pivotal role of the intermediate fragment in initial operative treatment of olecranon fractures

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    Hierholzer Christian


    Full Text Available Abstract Background In order to improve initial operative treatment of complex olecranon fractures we searched for new determining details. We assumed that the intermediate fragment plays a decisive role for anatomic restoration of the trochlear notch and consecutive outcome of initial operative treatment. Methods 80 patients operated with diagnosis of complex olecranon fracture were identified in an 8-year-period from trauma unit files at two European Level 1 Trauma Centers. Retrospective review of all operative reports and radiographs/computer-tomography scans identified patients with concomitance of an intermediate fragment. The Patient-Rated Elbow Evaluation Score was calculated for 45 of 80 patients at a minimum of 8 months postoperatively (range 8-84 months. Results 29 patients were treated with stable internal fixation with figure-of-eight tension band wire fixation and 51 patients with posterior plate osteosynthesis with/without intramedullary screw. An intermediate fragment was seen in 52 patients. In 29 of these 52 patients, the intermediate fragment was described in operative report. 24 of these 29 patients were treated with posterior plate osteosynthesis, and 5 patients with figure-of-eight tension band wiring. Complications included superficial infection (2 patients, secondary dislocation (3 patients and heterotopic ossifications (1 patient. Functional outcome demonstrated a total PREE score of 9 points on average in 45 of 80 patients. Conclusion An extraordinary amount of patients showed an intermediate fragment. Consideration, desimpaction and anatomic reduction of the intermediate fragment are necessary preconditions for anatomic restoration of the trochlear notch. There is no clear benefit for plating versus tension band wiring according to our data. In the operative report precise description of the fracture pattern including presence of an intermediate fragment is recommended.

  13. Clinical results of olecranon fractures treated with multiplanar locked intramedullary nailing. (United States)

    Argintar, Evan; Cohen, Mark; Eglseder, Andrew; Edwards, Scott


    Proximal ulnar fractures have traditionally been fixed with either tension band wiring or plate and screw fixation. These traditional techniques often irritate the surrounding soft tissues, potentially leading to subsequent secondary hardware removal surgeries. Intramedullary proximal ulnar fixation provides similar rigid fixation, however, no review yet exists to support the clinical use of currently available implants. To investigate the clinical and radiographic short-term outcomes for multiplanar locked intramedullary nails used to treat proximal ulnar fractures. A retrospective multicenter review was conducted in 28 patients with unstable olecranon fractures treated with a new multiplanar locked intramedullary nailing system (OlecraNail, Mylad Orthopedic Solutions, McLean, VA). Radiographic union was estimated, and serial clinical outcome up to one year was assessed by strength, motion, pain (visual analog scale), and a subcutaneous ulna border palpation (SCUBP) test to assess hardware prominence. All fractures achieved union by 8 weeks. At 12 weeks postoperatively, all motion was within 10 degrees of the contralateral side in all directions. Of the 18 patients who underwent SCUBP testing, all 18 patients reported to have no pain at 12 weeks. At one-year follow-up, all patients had resumed normal activities, including work and athletics. All of the patients who underwent the SCUBP testing continued to have no pain. Multiplanar locked intramedullary nails offer effective management for proximal ulna fractures similar to those reported with plating techniques. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  14. Type II olecranon fractures in patients over 65. Tension band or pre-formed plate? Analysis and results. (United States)

    Liñán-Padilla, A; Cáceres-Sánchez, L


    The objective of this study was to compare the clinical outcomes of surgical treatment using tension band with needles and preformed plates in type ii olecranon fractures according to the Mayo classification in patients older than 65 years. A descriptive, retrospective study of 49 patients with a mean age of 75.1 years who underwent surgery olecranon fracture using 2 different fixing systems. The Mayo classification was used to define them, excluding type i and iii, and the VAS to assess postoperative pain. Patients were assessed functionally by the questionnaire Quick DASH. All measurement was performed with goniometer and joint balance serial radiographs at one month, 3, 6 and 12 months. Minimum follow-up was one year. In 26 patients the tension band was used and the preformed plates in 23. There were no statistically significant differences in functional outcomes, joint balance or postoperative VAS between the 2 groups. There were a greater proportion of patients who had to be operated because of problems related to osteosynthesis material in those in which preformed plates were used. Treatment of olecranon fractures with tension band with needles and cerclage remains the surgery of choice in patients older than 65 years. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. K-wire position in tension-band wiring technique affects stability of wires and long-term outcome in surgical treatment of olecranon fractures.

    NARCIS (Netherlands)

    Linden, S.C. van der; Kampen, A. van; Jaarsma, R.L.


    BACKGROUND: Tension-band wiring (TBW) has been accepted as the treatment of choice for displaced olecranon fractures. The aim of this study was to examine the effect of K-wire position on instability of the K-wires in relation to local complications and radiological and clinical long-term outcome. M

  16. [Olecranon osteotomy in the treatment of distal humeral fractures in adults: anatomical and functional evaluation of the elbow in 14 cases]. (United States)

    Sané, A D; Dakouré, P W H; Diémé, C B; Kinkpé, C V A; Dansokho, A V; Ndiaye, A; Seye, S I L


    Osteotomy of the olecranon is commonly used to gain exposure for reconstruction of bi-condylar fractures of the distal humerus (type 13-C of classification AO), but there is controversy because of the considerable complications inherent in this technique. The aim of our study is to examine the anatomical and functional consequences of this technique of exposure on the elbow. This is a retrospective study over a continuous 7-year period. We confined ourselves to patients more than 15 years old who had presented with a bi-condylar fracture (type C of the AO) of the distal humerus, internally fixed through an osteotomy of the olecranon. We reexamined and evaluated 14 treated patients who had been operated in our service. There were nine men and five women with an average age of 34 years (range 17 to 70 years). According to the AO classification, we found 14 fractures distributed in the following way: three type C1, seven type C2 and four type C3; the fracture was open in two cases. The osteotomy was carried out in all the cases using an osteotome, extra-articular in six cases and intra-articular way in eight cases. Repair was always performed using tension band wiring. The evaluation was based on anatomical and functional criteria (Mayo Elbow Performance Score). No case of radial and ulnar paralysis was found. Thirty-six percent of the olecranon fixations were of bad quality and we found one case of olecranon pseudarthrosis. No case of heterotypic calcification was found, on the other hand, there was a case of post-traumatic osteoarthritis of the elbow. On the functional level, we obtained 36% of excellent results, 28.5% of good results, 7% of average results and 28.5% of bad results. Osteotomy of the olecranon is one of the techniques for exposure of the articular surface during reconstruction of fractures of the distal humerus. A rigorous technique allows one to avoid complications.

  17. An olecranon chondral flap and osteochondral coronoid fracture in a spontaneously reduced elbow dislocation in a child. (United States)

    Quick, Tom J; Gibbons, Paul; Smith, Nick


    Elbow injuries in children are very common and radiographs are often difficult to interpret because of the radiolucency of the cartilaginous anlage and the progressive appearance of multiple secondary ossification centres. Elbow dislocations are rare injuries in children. Coronoid fractures can occur during dislocation or relocation of the elbow and can be the only hallmark of a severe injury. The understanding of the mechanics of these injuries has undergone considerable evolution over the past decade. Intra-articular chondral flap fractures are a traumatic elevation of the hyaline cartilage from the subchondral bone. They are also rare injuries in children but should be included in the differential when examining an injured joint. The infrequency of these injuries provides little opportunity to become accustomed to the radiographic signs. We present a case report of a 4-year-old boy with both an olecranon chondral flap and coronoid cartilaginous fracture after a joint dislocation. We present his plain radiography and MRI with illustrated photographic records of the operative findings. This injury has been little described in the literature and never with such imaging to aid understanding of both the pathology and the injury mechanism.

  18. Tubercular arthritis of the elbow joint following olecranon fracture fixation and the role of TGF-beta in its pathogenesis

    Institute of Scientific and Technical Information of China (English)

    Masood Habib; Yashwant Singh Tanwar; Atin Jaiswal; Rajender Kumar Arya


    Tuberculosis (TB) occurring after a closed bone fracture in the patient with no history of TB and no evidence of TB infection at the time of initial fracture is a rare entity.We report one such case of a 48-year-old female,who presented in the emergency department with an olecranon fracture which was open reduced and internally fixed with tension band wiring.Patient presented in the outpatient department with serosanguineous discharge at 3 weeks after surgery.The discharge was sent for culture and sensitivity tests,and the patient was managed by antibiotics and daily dressings.There was wound dehiscence and the underlying implant was exposed,which was removed at 12 weeks after surgery.Repeat debridements and dressings continued for 6 months,but the discharge from the wound site continued.X-rays of the elbow performed at 6 months raised the suspicion of TB,which was confirmed by Ziel-Neelsen staining and histopathological examination of the debrided tissue.Following the confirmation,patient was put on antitubercular drugs.The patient responded to antitubercular drug therapy (ATT),the purulent discharge from the wound ceased,and eventually the wound healed after 2 months of starting ATT.

  19. Olecranon bursitis. (United States)

    Reilly, Danielle; Kamineni, Srinath


    Bursitis is a common medical condition, and of all the bursae in the body, the olecranon bursa is one of the most frequently affected. Bursitis at this location can be acute or chronic in timing and septic or aseptic. Distinguishing between septic and aseptic bursitis can be difficult, and the current literature is not clear on the optimum length or route of antibiotic treatment for septic cases. The current literature was reviewed to clarify these points. The reported data for olecranon bursitis were compiled from the current literature. The most common physical examination findings were tenderness (88% septic, 36% aseptic), erythema/cellulitis (83% septic, 27% aseptic), warmth (84% septic, 56% aseptic), report of trauma or evidence of a skin lesion (50% septic, 25% aseptic), and fever (38% septic, 0% aseptic). General laboratory data ranges were also summarized. Distinguishing between septic and aseptic olecranon bursitis can be difficult because the physical and laboratory data overlap. Evidence for the optimum length and route of antibiotic treatment for septic cases also differs. In this review we have presented the current data of offending bacteria, frequency of key physical examination findings, ranges of reported laboratory data, and treatment practices so that clinicians might have a better guide for treatment. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  20. Societal costs in displaced transverse olecranon fractures: using decision analysis tools to find the most cost-effective strategy between tension band wiring and locked plating. (United States)

    Francis, Tittu; Washington, Travis; Srivastava, Karan; Moutzouros, Vasilios; Makhni, Eric C; Hakeos, William


    Tension band wiring (TBW) and locked plating are common treatment options for Mayo IIA olecranon fractures. Clinical trials have shown excellent functional outcomes with both techniques. Although TBW implants are significantly less expensive than a locked olecranon plate, TBW often requires an additional operation for implant removal. To choose the most cost-effective treatment strategy, surgeons must understand how implant costs and return to the operating room influence the most cost-effective strategy. This cost-effective analysis study explored the optimal treatment strategies by using decision analysis tools. An expected-value decision tree was constructed to estimate costs based on the 2 implant choices. Values for critical variables, such as implant removal rate, were obtained from the literature. A Monte Carlo simulation consisting of 100,000 trials was used to incorporate variability in medical costs and implant removal rates. Sensitivity analysis and strategy tables were used to show how different variables influence the most cost-effective strategy. TBW was the most cost-effective strategy, with a cost savings of approximately $1300. TBW was also the dominant strategy by being the most cost-effective solution in 63% of the Monte Carlo trials. Sensitivity analysis identified implant costs for plate fixation and surgical costs for implant removal as the most sensitive parameters influencing the cost-effective strategy. Strategy tables showed the most cost-effective solution as 2 parameters vary simultaneously. TBW is the most cost-effective strategy in treating Mayo IIA olecranon fractures despite a higher rate of return to the operating room. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  1. Isolated olecranon fractures in children affected by osteogenesis imperfecta type I treated with single screw or tension band wiring system: Outcomes and pitfalls in relation to bone mineral density. (United States)

    Persiani, Pietro; Ranaldi, Filippo M; Graci, Jole; De Cristo, Claudia; Zambrano, Anna; D'Eufemia, Patrizia; Martini, Lorena; Villani, Ciro


    The purpose of this study is to compare the results of 2 techniques, tension band wiring (TBW) and fixation with screws, in olecranon fractures in children affected with osteogenesis imperfecta (OI) type I. Between 2010 and 2014, 21 olecranon fractures in 18 children with OI (average age: 12 years old) were treated surgically. Ten patients were treated with the screw fixation and 11 with TBW. A total of 65% of olecranon fractures occurred as a result of a spontaneous avulsion of the olecranon during the contraction of the triceps muscle. The average follow-up was 36 months. Among the children treated with 1 screw, 5 patients needed a surgical revision with TBW due to a mobilization of the screw. In this group, the satisfactory results were 50%. In patients treated with TBW, the satisfactory results were 100% of the cases. The average Z-score, the last one recorded in the patients before the trauma, was -2.53 in patients treated with screw fixation and -2.04 in those treated with TBW. TBW represents the safest surgical treatment for patients suffering from OI type I, as it helps to prevent the rigidity of the elbow through an earlier recovery of the range of motion, and there was no loosening of the implant. In analyzing the average Z-score before any fracture, the fixation with screws has an increased risk of failure in combination with low bone mineral density.

  2. Olecranon bone graft: revisited. (United States)

    Mersa, Berkan; Ozcelik, Ismail Bulent; Kabakas, Fatih; Sacak, Bulent; Aydin, Atakan


    Autogenous bone grafts are frequently in use in the field of reconstructive upper extremity surgery. Cancellous bone grafts are applied to traumatic osseous defects, nonunions, defects after the resection of benign bone tumors, arthrodesis, and osteotomy procedures. Cancellous bone grafts do not only have benefits such as rapid revascularization, but they also have mechanical advantages. Despite the proximity to the primary surgical field, cancellous olecranon grafts have not gained the popularity they deserve in the field of reconstructive hand surgery. In this study, the properties, advantages, and technical details of harvesting cancellous olecranon grafts are discussed.

  3. Elbow (Olecranon) Bursitis (United States)

    .org Elbow (Olecranon) Bursitis Page ( 1 ) Bursae are thin, slippery sacs located throughout the body that act as cushions between bones and so ... more fluid will accumulate in the bursa and bursitis will develop. Cause Elbow bursitis can occur for ...

  4. Bilateral Olecranon Tophaceous Gout Bursitis


    Güzelali Özdemir; Alper Deveci; Kemal Andıç; Niyazi Erdem Yaşar


    In this case, we present a patient with the diagnosis of bilateral olecranon tophaceous gout. After the surgical treatment, there was no limitation of range of motion or wound problem at 6th month control.

  5. Bilateral Olecranon Tophaceous Gout Bursitis

    Directory of Open Access Journals (Sweden)

    Güzelali Özdemir


    Full Text Available In this case, we present a patient with the diagnosis of bilateral olecranon tophaceous gout. After the surgical treatment, there was no limitation of range of motion or wound problem at 6th month control.

  6. Septic and non-septic olecranon bursitis in the accident and emergency department--an approach to management. (United States)

    Stell, I M


    Olecranon bursitis is relatively common. One third of episodes are septic. Most of the remainder are non-septic, with occasional rheumatological causes. Trauma can cause both septic and non-septic olecranon bursitis. Clinical features are helpful in separating septic from non-septic olecranon bursitis, but there may be local erythema in both. Aspiration should be carried out in all cases, and if the presence of infection is still in doubt, microscopy, Gram staining, and culture of the aspirate will resolve the issue. Septic olecranon bursitis should be treated by aspiration, which may need to be repeated, and a long course of antibiotics. Some cases will need admission, and a few will need surgical treatment. Non-septic olecranon bursitis can be managed with aspiration alone. Non-steroidal anti-inflammatory drugs probably hasten symptomatic improvement. Intrabursal corticosteroids produce a rapid resolution but concern remains over their long term local effects. Recovery from septic olecranon bursitis can take months. PMID:8894865

  7. 腓骨切开复位内固定与胫骨闭合复位外支架固定治疗胫腓骨下段粉碎性骨折%Minimally invasiw treatment of fractures of distal one-third of tibia-fibular

    Institute of Scientific and Technical Information of China (English)

    于珂; 宋锋; 戚超


    目的 探讨对胫腓骨下段粉碎性骨折微创治疗方法的效果.方法 胫腓骨下段粉碎性骨折36例,男21例,女15例;年龄12~5岁,平均38.5岁.其中闭合性骨折24例,Ⅰ度开放性骨折10例,Ⅱ度开放性骨折2例.采用单侧外固定支架与钢板螺丝钉结合微创治疗胫腓骨下段骨折.结果 本组均获6个月~1年随访,平均9个月.定期X线复查,X线片示腓骨均解剖愈合,胫骨均功能位愈合,骨折临床愈合时间平均6个月.无软组织感染和骨髓炎发生.膝关节活动度大于90°,踝关节活动度15°~30°间,并达到骨愈合标准后拆除外固定架.去固定时间12~32周,平均24周,拆除崮定后无再骨折发生.结论 对于复杂粉碎性胫腓骨下段骨折的治疗,腓骨切开复位内固定与胫骨闭合复位外支架固定,操作简单、固定可靠、手术创伤小、符合微创术式原则.这为胫腓骨下段粉碎性骨折的治疗提供了有效的治疗方法,值得进一步的推广.%Objective To observe the clinical effect of minimally invasive treatment of comminuted fractures of distal onethird of tibia-fibular. Methods 3 o patients with fractures of distal one-third of tibia-fibular,24 patients were closed.10 patients were Ⅰ-degree open fracture,2 patients were Ⅱ-degree open fracture. 21 males,15 females,with a mean age of 38.5 years(range12~65).The fractures were fixed by steel plates combined with unilateral extemal fixing frame .Results All patients were followed up 6 to 12 months(average 9 months) and acquired the bone was union.The mean time of bone union was 6 months.None of the patients had soft tissues infection and osteomyelitis.The range of motion in the knee was above 90°, The range of motion in the ankle was 15°~30°,the frame was removed after bone union ,the mean frame time was 24 weeks(12~32weeks). Conclusion Providing reliable reposion and fixation, internal fixation of fibula plus external fram fixtion of tibia is an

  8. Intraosseous ganglion cyst of olecranon

    Directory of Open Access Journals (Sweden)

    Abolghasem Zarezadeh


    Full Text Available Intraosseous ganglia are benign cysts that usually can be seen in lower extremity; especially around ankle. These cysts have fewer incidences in upper extremity, mainly around the wrist. They are extremely rare in olecranon. These lesions are often asymptomatic. Patient was a 75-year-old man who had trauma many years ago. When he came to our clinic, he complained of severe pain around his elbow that he could not do ordinary activity. He had local tenderness in elbow and 30 degree limitation in extension. In radiography, lytic, multiloculated lesion existed in region of olecranon. After excisional biopsy was done, cavity was cleaned completely with curette and was filled with autogenous bone. At 10-year follow-up, the patient was completely asymptomatic. Control radiograph showed cavity filled completely by bone; there was no evidence of relapse.

  9. [The bare area of the proximal ulna : An anatomical study on optimizing olecranon osteotomy]. (United States)

    Hackl, M; Lappen, S; Neiss, W F; Scaal, M; Müller, L P; Wegmann, K


    Olecranon osteotomy is an established approach for the treatment of distal humerus fractures. It should be performed through the bare area of the proximal ulna to avoid iatrogenic cartilage lesions. The goal of this study was to analyze the anatomy of the proximal ulna with regard to the bare area and, thereby, to optimize the hitting area of the bare area when performing olecranon osteotomy. The bare areas of 30 embalmed forearm specimens were marked with a radiopaque wire and visualized three-dimensionally with a mobile C‑arm. By means of 3D reconstructions of the data sets, the following measurements were obtained: height of the bare area; span of the bare area-hitting area in transverse osteotomy; ideal angle for olecranon osteotomy to maximize the hitting area of the bare area; distance of the posterior olecranon tip to the entry point of the transverse osteotomy and the ideal osteotomy. The height of the bare area was 4.92 ± 0.81 mm. The hitting area of the transverse osteotomy averaged 3.73 ± 0.89 mm. The "ideal" angle for olecranon osteotomy was 30.7° ± 4.19°. The distance of the posterior olecranon tip to the entry point was 14.08 ± 2.75 mm for the transverse osteotomy and 24.21 ± 3.15 mm for the ideal osteotomy. The hitting area of the bare area in the ideal osteotomy was enhanced significantly when compared to the transverse osteotomy (p osteotomy of the olecranon. Moreover, a 30° angulation of the osteotomy can significantly increase the hitting area of the bare area.

  10. Olecranon bursitis: a systematic overview (United States)

    Hay, Bruce A; Bolt, Alexander M; Hay, Stuart M


    Background Olecranon bursitis is a common condition where the bursal cavity, superficial to the olecranon, becomes inflamed. This can occur either with or without infection and has been given pseudonyms relating to the repeated minor trauma from external pressure that often predisposes. As a result of the multiple aetiologies, olecranon bursitis can present to any medical specialty with reasonable frequency and, although many therapies are described, a single, evidence-based and standardized treatment pathway is not well described. Methods We summarize the key points within the literature and subsequently propose an evidence-based treatment pathway. Results Relevant evidence is presented from appropriate publications to add rational to existing decision-making processes, together with personal experience and suggested operative bursectomy techniques from an established upper limb surgeon. The common and significant aetiologies are summarized and, in particular, red flag symptoms are highlighted by way of warning to the unsuspecting investigator. Conclusions The conclusion is provided in diagrammatic form, providing a suggested treatment pathway from history and examination through to operative intervention. PMID:27582935

  11. 肱三头肌两侧入路与尺骨鹰嘴截骨入路治疗肱骨髁间骨折疗效对比研究%Comparative study of clinical outcome between triceps sparring and olecranon osteotomy approach in the treatment of humeral intercondylar fractures

    Institute of Scientific and Technical Information of China (English)

    王光超; 纪方; 章浩; 贺倩芸; 刘康; 丁晨


    .The current commonly used surgical approaches are olecranon osteotomy approach,triceps sparring approach and triceps tongue-shaped flap approach. The triceps tongue-shaped flap approach requires triceps transection,resulting in poor strength of elbow extension,plaster external fixation of 3 weeks without early functional exercise,extensive adhesions between triceps brachii and surrounding tissue of distal humerus,and high rate of joint stiffness,which is rarely used in our hospital at present.This paper aims to compare the therapeutic effects of the former two approaches and provide the basis for their clinical application values.Methods From September 2008 to September 2013,87 patients,including 54 males and 33 females were treated for humeral condylar fractures in the orthopedic department of our hospital.The ages ranged from 21 to 57 years old and the mean age was 35.7 years.According to AO/ASIF classification,26 cases were type C1,39 cases were type C2 and 22 cases were type C3.All patients had a clear history of trauma and were confirmed by X-ray films or CT scans.The patients with surgical contraindications such as hematological disorders,acute infection, severe liver and kidney dysfunctions,etc.were excluded.The causes of fracture included traffic accidents in 37 cases, falling injuries in 27 cases,impact lesions and hit injuries in 14 cases and others in 9 cases.All the patients showed the symptoms and signs of severe pain, swelling, tenderness, abnormal limb activities,bone crepitus and bone friction feeling. According to different surgical methods, the patients were divided into the observation group (45 cases)and the control group (42 cases).There was no statistical significance but compatibly between two group (P >0.05)in the aspects of gender, age, body mass index, bone classification, etc.Operation methods routine examinations and preparations were accomplished preoperatively,and general anesthesia or brachial plexus block was selected as the anesthesia method

  12. Treatment of C3 Type Fracture of Distal Humerus through the Double-plate Internal Fixation of the Olecranon Osteotomy%经鹰嘴截骨双钢板内固定治疗C3型肱骨远端骨折

    Institute of Scientific and Technical Information of China (English)

    周建全; 张海林; 邹锐; 殷剑伟; 龚建华


    目的 探讨肱骨远端C3型骨折的入路选择及内固定钢板的放置方法.方法 选择2004年1月至2010年11月我院收治的肱骨远端骨折患者56例,其中C3型骨折32例,全部采用经鹰嘴截骨显露肱骨远端,肱骨内外侧解剖钢板90°放置内固定的手术治疗.所有病例均随访9 ~15个月,平均11.3个月.结果 32例患者切口均一期愈合,所有骨折骨性愈合,无内固定松动及退针出现;未出现骨化性肌炎;按改良Broberg和Morrey评分系统,优18例,良9例,可4例,差1例,优良率为84.4%.结论 经鹰嘴截骨、90°双钢板内固定治疗C3型骨折,具有暴露充分、直视下良好整复关节面、内固定坚强可靠的优点,能满足早期功能锻炼的要求,符合国际内固定研究协会关节内骨折的治疗原则,是一种治疗复杂性肱骨远端骨折的可靠方法.%Objective To explore the approaching choice of C3 type fracture of distal humerus and the placement method of internal fixation plate. Methods 56 patients admitted to our hospital from January 2004 to November2010,for the distal humerus fractures including 32 cases of C3 fractures,all received the o-lecranon osteotomy,lateral and medial anatomy of the humerus plate 90°fixation surgical treatment; all cases were followed up for 9 to 15 months with an average of 11. 3 months. Results Incision of 32 patients healed in the first stage,all fractures healed and no internal fixation pin loosening and back,no myositis ossificans. According to the modified Broberg and Morrey scoring system,excellent in 18 cases,good in 9 cases,fair in 4 cases and poor in 1 case. Excellent and good rate was 84.4%. Conclusion The olecranon osteotomy,which can effectively heal C3 type fracture of distal humerus through the 90° internal fixation, is featured with the advantages of full exposion and good vision of the entire articular surface under direct sight, and strong and reliable fixation, which could meet the requirements of


    Institute of Scientific and Technical Information of China (English)

    杨秋军; 孙国栋


    目的:评价双钢板固定手术治疗肱骨髁间骨折的临床疗效。方法该组患者31例,男19例,女12例,年龄20~64岁,平均38.2岁;高处坠落伤10例,交通事故伤16例,重物压砸伤5例。均为 C3型肱骨髁间骨折,全部经尺骨鹰嘴入路应用双钢板内固定治疗,用 Jupiter 肘关节功能评分标准行术后患肘功能评分。结果31例均获得随访,术后平均随访时间为15个月。平均愈合时间为4个月。所有截骨块全部愈合,平均愈合时间8周。按改良 Jupiter 肘关节评分标准:优24例,良 4例,可 2例,优良率90.3%。结论经尺骨鹰嘴截骨入路双钢板固定治疗 C3型肱骨髁间骨折具有固定牢靠、并发症少、满意率高等优点,可早期进行功能锻炼,是一种较好的治疗肱骨髁间骨折的内置物。%Objective To explore the clinical efficacy for treatment of humeral intercondylar fracture with the two steel plate .Methods Thirty - one patients which were consisted of twenty - one men and ten women ,age 20 - 64 ,were divided into three groups :10 cases of fall injury ,16 cases of traffic accidents ,6 cases of heavy crash injury ;All patients were humeral intercondylar fracture of type C3 ,adopted chevron osteotomy of the olecranon approach and internal fixation with the two steel plate ,and postoperative elbow join function score was performed with Jupiter elbow joint function score standard .Results Totally 31 pa‐tients were all followed - up ,the average follow - up period was 15 months .The average healing time was 4 months .All bone cutting piece were healed ,with an average healing time of 8 weeks .According to the Jupiter elbow grading standard ,the results were excellent in 12 cases ,good in 4 cases and ok in 2 cases ,the perfect rate was 90 .3% .Conclusion Chevron osteotomy of the olecranon with the two steel plate is a bet‐ter way to treat distal humeral fracture of type C3 ,the advantages is

  14. The treatment of the olecranon comminuted fracture by angle stability principle combined with support under the artic-ular surface%角稳定钢板结合关节面下支撑治疗关节面粉碎的尺骨鹰嘴骨折

    Institute of Scientific and Technical Information of China (English)

    王世龙; 汤超亮; 张权; 陈文钧


    Objective To evaluate the treatment effects of the olecranon comminuted fracture by the angle stability prin-ciple combined with support under the articular surface. Methods From November 2008 to June 2012, 13 patients (7 male and 6 female, aged from 20 to 77 years) suffered from olecranon comminuted fracture were treated with Synthes anatomy locking com-pression plate and screws combined with Kirschner wires supporting under the articular surface through the posterior median ap-proach. Fractures occurred in the left elbow in 9 and in the right elbow in 4. According to the Mayo classification, 11 cases were classified as Mayo type IIB and 2 as IIIB. According to the Schatzker-Schmeling classification, 2 fractures were type A2, 9 type C, and 2 type D. One patient with type C fracture also had type I coronoid fracture according to Regan and Morrey classification. The Mayo elbow performance index (MEPI) and the shortened disabilities of the arm shoulder and hand (Quick-DASH) were employed to evaluate the functions. All patients took the satisfaction survey and X-ray during the follow-up. Results All patients were fol-lowed-up for 8 to 41 months. The mean ROM of the elbow joint was 112° (range, 65°-140° ), and the mean rotation angle of the forearm was 170° (range, 150°-180°). The mean score for the MEPI was 96 (range, 85-100), excellent 12, good 1. The mean score for the Quick-DASH was 6.2 (range, 0-16.7). In the satisfaction survey, 8 patients were very satisfied, 4 satisfied, 1 common level. All patients took the X-ray during the follow-up and all of them had achieved fracture union completely with the mean time period as 12.7 weeks (range, 11-24 weeks). No cubitus varus, valgus, and instability were found in all patients. No complication, such as infection, ulnar nerve injuries and etc. was found. Five patients complained about mild discomfort caused by internal fixation at 3 months after surgery. Three of them were diagnosed as joint stiffness because of ROM

  15. Treatment of olecranon bursitis: a systematic review. (United States)

    Sayegh, Eli T; Strauch, Robert J


    The optimal management of olecranon bursitis is ill-defined. The purposes of this review were to systematically evaluate clinical outcomes for aseptic versus septic bursitis, compare surgical versus nonsurgical management, and examine the roles of corticosteroid injection and aspiration in aseptic bursitis. The English-language literature was searched using PubMed, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, Allied and Complementary Medicine, and Cochrane Central Register of Controlled Trials. Analyses were performed for clinical resolution and complications after treatment of aseptic and/or septic olecranon bursitis. Twenty-nine studies containing 1278 patients were included. Compared with septic bursitis, aseptic bursitis was associated with a significantly higher overall complication rate (p = 0.0108). Surgical management was less likely to clinically resolve septic or aseptic bursitis (p = 0.0476), and demonstrated higher rates of overall complications (p = 0.0117), persistent drainage (p = 0.0194), and bursal infection (p = 0.0060) than nonsurgical management. Corticosteroid injection for aseptic bursitis was associated with increased overall complications (p = 0.0458) and skin atrophy (p = 0.0261). Aspiration did not increase the risk of bursal infection for aseptic bursitis. Based primarily on level IV evidence, nonsurgical management of olecranon bursitis is significantly more effective and safer than surgical management. The clinical course of aseptic bursitis appears to be more complicated than that of septic bursitis. Corticosteroid injection is associated with significant risks without improving the outcome of aseptic bursitis. Therapeutic IV.

  16. Treatment of nonunions of the distal phalanx with olecranon bone graft. (United States)

    Ozçelik, I B; Kabakas, F; Mersa, B; Purisa, H; Sezer, I; Ertürer, E


    Distal phalangeal fractures are the most common fractures of the hand but nonunions are unusual in the distal phalanx. Eleven patients were operated on for nonunions of the distal phalanx. The diagnosis of nonunion was made by the presence of the clinical (pain, deformity, instability) and radiological signs of nonunion more than 4 months after the initial injury. Three patients had developed infection and four of them had bone resorption after their initial treatments, which probably caused nonunion. Olecranon bone grafting combined with Kirschner wire fixation was done in all patients. The mean follow up was 7 months (range 5-18 months). There were no major complications at the donor or recipient sites. One patient had a haematoma formation at the donor site. There was complete radiological union of bone-grafted sites in all patients except one. There were no cases of pain, deformity, or instability after the treatment. The olecranon bone graft was found to be safe and easy to harvest. Its strong tubular structure replaced the distal phalanx successfully.

  17. Rare giant cell tumor involvement of the olecranon bone. (United States)

    Yang, Chen; Gong, Yubao; Liu, Jianguo; Qi, Xin


    Giant cell tumor (GCT) of bone is a relatively common benign bone lesion and is usually located in long bones, but involvement of the olecranon is extremely rare. Here, we present a case of solitary GCT of bone in the olecranon that was confirmed by preoperative needle biopsy and postoperative histological examination. The treatment included intralesional curettage, allogeneic bone grafting, and plating. At 26 months follow-up, the patient had no local recurrence.

  18. Rare giant cell tumor involvement of the olecranon bone

    Directory of Open Access Journals (Sweden)

    Chen Yang


    Full Text Available Giant cell tumor (GCT of bone is a relatively common benign bone lesion and is usually located in long bones, but involvement of the olecranon is extremely rare. Here, we present a case of solitary GCT of bone in the olecranon that was confirmed by preoperative needle biopsy and postoperative histological examination. The treatment included intralesional curettage, allogeneic bone grafting, and plating. At 26 months follow-up, the patient had no local recurrence.

  19. Diagnosis and management of olecranon bursitis. (United States)

    Del Buono, Angelo; Franceschi, Francesco; Palumbo, Alessio; Denaro, Vincenzo; Maffulli, Nicola


    We aim to review the current knowledge on diagnosis, clinical features and main management modalities of olecranon bursitis. We underline that the first treatment line is conservative, including ice, rest, anti-inflammatory and analgesic drugs and, occasionally, bursal fluid aspiration. In unresponsive patients, although open excisional procedures allow to completely remove the pathological bursal tissue, arthroscopy is increasingly being considered as a suitable new modality of management. These minimally invasive procedures, although not free from complications, avoid the wound problems often occurring following open excision. Copyright © 2012 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  20. Candida glabrata olecranon bursitis treated with bursectomy and intravenous caspofungin. (United States)

    Skedros, John G; Keenan, Kendra E; Trachtenberg, Joel D


    Orthopedic surgeons are becoming more involved in the care of patients with septic arthritis and bursitis caused by yeast species. This case report involves a middle-aged immunocompromised female who developed a Candida glabrata septic olecranon bursitis that developed after she received a corticosteroid injection in the olecranon bursa for presumed aseptic bursitis. Candida (Torulopsis) glabrata is the second most frequently isolated Candida species from the bloodstream in the United States. Increased use of fluconazole and other azole antifungal agents as a prophylactic treatment for recurrent Candida albicans infections in immunocompromised individuals is one reason why there appears to be increased resistance of C. glabrata and other nonalbicans Candida (NAC) species to fluconazole. In this patient, this infection was treated with surgery (bursectomy) and intravenous caspofungin, an echinocandin. This rare infectious etiology coupled with this intravenous antifungal treatment makes this case novel among cases of olecranon bursitis caused by yeasts.

  1. Rural electrification in Chihuahua, Mexico at one third of the cost vs a conventional substation

    Energy Technology Data Exchange (ETDEWEB)

    Ramirez, Omar; Gomez, Rolando; Solano, Arturo; Acosta, Eduardo


    This paper and presentation describes technical details about a successful experience in a unique project in Mexico for making possible the rural electrification at one third of the total cost vs a traditional substation. This alternate solution for electrification of rural communities where construction of distribution lines or traditional substations are not economically possible due to local government's budget limits or because the electrical companies are looking for the ROI Return Over Investment in poverty communities.

  2. Pediatric elbow fractures: a new angle on an old topic

    Energy Technology Data Exchange (ETDEWEB)

    Emery, Kathleen H.; Anton, Christopher G. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Zingula, Shannon N. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Salisbury, Shelia R. [Cincinnati Children' s Hospital Medical Center, Biostatistics and Epidemiology, Cincinnati, OH (United States); Tamai, Junichi [Cincinnati Children' s Hospital Medical Center, Department of Pediatric Orthopedics, Cincinnati, OH (United States)


    The three most common elbow fractures classically reported in pediatric orthopedic literature are supracondylar (50-70%), lateral condylar (17-34%), and medial epicondylar fractures (10%), with fractures of the proximal radius (including but not limited to fractures of the radial neck) being relatively uncommon (5-10%). Our experience at a large children's hospital suggests a different distribution. Our goals were (1) to ascertain the frequency of different elbow fracture types in a large pediatric population, and (2) to determine which fracture types were occult on initial radiographs but detected on follow-up. Review of medical records identified 462 children, median age 6 years and interquartile range for age of 4-8 years (range 0.8-18 years), who were diagnosed with elbow fractures at our institution over a 10-month period. Initial and follow-up radiographs were reviewed in blinded fashion independently by two experienced pediatric musculoskeletal radiologists to identify fracture types on initial and follow-up radiographs. The most common fractures included supracondylar (n = 258, 56%), radial neck (n = 80, 17%), and lateral condylar (n = 69, 15%). Additional fractures were seen on follow-up exams in 32 children. Of these, 25 had a different fracture type than was identified on initial radiographs. The most common follow-up fractures were olecranon (n = 23, 72%), coronoid process (n = 4, 13%) and supracondylar (n = 3, 9%). Olecranon fractures were significantly more common on follow-up radiographs than they were on initial radiographs (n = 33, 7%; P <.0001). Twenty-six children had more than one fracture type on the initial radiograph. The most common fracture combinations were radial neck with olecranon (n = 9) and supracondylar with lateral condylar (n = 9). Supracondylar fractures are the most frequent elbow fracture seen initially, followed by radial neck, lateral condylar, and olecranon fractures in a distribution different from what has been

  3. Therapy-resistant septic olecranon bursitis due to Mycobacterium gordonae (United States)

    Konrads, Christian; Rückl, Kilian; El Tabbakh, Mohammed; Rudert, Maximilian; Kircher, Stefan; Plumhoff, Piet


    Introduction: Septic olecranon bursitis due to atypical mycobacteria is rare. An insidious beginning can delay diagnosis and treatment. Antibacterial therapy recommendations are not well-defined for bursitis caused by atypical mycobacteria. We present a rare case of olecranon bursitis caused by Mycobacterium gordonae, reporting our experiences regarding pathogen identification and antibiotic therapy, which differs from regimes used in common septic bursitis mostly caused by staphylococcus aureus. Methods: A 35-year-old male with bursitis olecrani received open bursectomy. Microbiological culture did not reveal bacteria. Due to wound healing complications revision surgery was performed four weeks postoperatively. Finally, Mycobacterium gordonae was identified by PCR and an antibiogram could be developed. A triple antimicrobial combination therapy with Rifampicin, Clarithromycin, and Ethambutol was administered systemically for 12 months. The patient was followed-up for 24 months. Results: After the second operation with pathogen identification and antibiotic combination therapy the wound healed without any additional complications. At last follow-up 24 months after the first surgery with bursectomy and 23 months after revision surgery with debridement, the patient was still pain free with no significant clinical findings or tenderness to touch at the operation site. Elbow range of motion was full. Discussion: As septic bursitis can be caused by many different and sometimes rare and difficult to identify bacteria, intraoperative probes should be taken and histopathological and microbiological analysis should be conducted, including PCR. In a young man with olecranon bursitis due to Mycobacterium gordonae surgical treatment and an antibiotic combination therapy showed a good clinical outcome after one and two years. PMID:27892398

  4. Magnetic order-disorder transitions on a one-third-depleted square lattice (United States)

    Guo, H.-M.; Mendes-Santos, T.; Pickett, W. E.; Scalettar, R. T.


    Quantum Monte Carlo simulations are used to study the magnetic and transport properties of the Hubbard model, and its strong coupling Heisenberg limit, on a one-third-depleted square lattice. This is the geometry occupied, after charge ordering, by the spin-1/2 Ni1 + atoms in a single layer of the nickelate materials La4Ni3O8 and (predicted) La3Ni2O6 . Our model is also a description of strained graphene, where a honeycomb lattice has bond strengths which are inequivalent. For the Heisenberg case, we determine the location of the quantum critical point (QCP) where there is an onset of long range antiferromagnetic order (LRAFO), and the magnitude of the order parameter, and then compare with results of spin wave theory. An ordered phase also exists when electrons are itinerant. In this case, the growth in the antiferromagnetic structure factor coincides with the transition from band insulator to metal in the absence of interactions.

  5. Light environment within a leaf. II. Progress in the past one-third century. (United States)

    Ichiro, Terashima; Hiroki, Ooeda; Takashi, Fujita; Riichi, Oguchi


    Studies directly related to light environments within a leaf, conduced mainly in the past one-third century, are reviewed. In particular, studies that revealed the profiles of light absorption and photosynthetic capacity are highlighted. Progress in this research field has been accelerated by devising innovative techniques. Roles of the main photosynthetic tissues, the palisade and spongy tissues, as the light guide and diffuser, respectively, are discussed. When the leaf is illuminated with diffuse light, light is absorbed more by the chloroplasts located near the illuminated surface. The meanings of the occupation of the mesophyll surfaces facing the intercellular spaces by chloroplasts and chloroplast movement are also discussed. The discrepancy between the light absorption profile and that of photosynthetic capacity is examined most intensively.

  6. [Current treatment concepts for olecranon and prepatellar bursitis in Austria]. (United States)

    Baumbach, S F; Michel, M; Wyen, H; Buschmann, C T; Kdolsky, R; Kanz, K-G


    The limited evidence available on the diagnosis and treatment of olecranon and prepatellar bursitis indicates nationally varying treatment approaches. Therefore the aim of this study was to survey the current treatment concepts of olecranon and prepatellar bursitis in Austria. An online questionnaire comprising of demographic data, questions regarding diagnostics and differentiation between septic bursitis (SB) and non-septic bursitis (NSB) as well as two case reports for therapy appraisal were sent to members of the Austrian Society of Orthopaedics and Orthopaedic Surgery (ÖGO) and the Austrian Society of Traumatology (ÖGU). The overall response rates were 46 % (ÖGU)/12 % (ÖGO). Differentiation between SB and NSB was predominantly based on medical history/clinical presentation (ÖGU: 100 %/ÖGO: 84 %) and blood sampling (ÖGU: 82 %/ÖGO: 77 %). 64/36 % of surveyed members of ÖGO/OGU performed a bursal aspiration. 95/55 % of Austrian ÖGU opinion leaders favoured a surgical treatment approach in cases of SB/NSB. Conversely, ÖGO members rather favoured a conservative treatment approach (28/27 %). Significant differences were found between ÖGO and ÖGU, with the latter favouring a surgical treatment approach in cases of SB and NSB. However, the international literature argues for a conservative treatment approach. Further high quality research is needed to establish an evidence-based treatment approach. Georg Thieme Verlag KG Stuttgart · New York.

  7. First report of Nocardia asiatica olecranon bursitis in an immunocompetent traveler returning to Austria. (United States)

    Leitner, Eva; Valentin, Thomas; Hoenigl, Martin; Lanz, Philipp; Flick, Holger; Zollner-Schwetz, Ines; Grisold, Andrea J; Feierl, Gebhard; Krause, Robert


    Nocardia spp. are rarely isolated in extrapulmonary clinical specimens. We describe the first case of olecranon bursitis caused by Nocardia asiatica. The patient, a traveler returning from Thailand, was successfully treated with linezolid.

  8. Trimeric microsomal glutathione transferase 2 displays one third of the sites reactivity. (United States)

    Ahmad, Shabbir; Thulasingam, Madhuranayaki; Palombo, Isolde; Daley, Daniel O; Johnson, Kenneth A; Morgenstern, Ralf; Haeggström, Jesper Z; Rinaldo-Matthis, Agnes


    Human microsomal glutathione transferase 2 (MGST2) is a trimeric integral membrane protein that belongs to the membrane-associated proteins in eicosanoid and glutathione metabolism (MAPEG) family. The mammalian MAPEG family consists of six members where four have been structurally determined. MGST2 activates glutathione to form a thiolate that is crucial for GSH peroxidase activity and GSH conjugation reactions with electrophilic substrates, such as 1-chloro-2,4-dinitrobenzene (CDNB). Several studies have shown that MGST2 is able to catalyze a GSH conjugation reaction with the epoxide LTA4 forming the pro-inflammatory LTC4. Unlike its closest homologue leukotriene C4 synthase (LTC4S), MGST2 appears to activate its substrate GSH using only one of the three potential active sites [Ahmad S, et al. (2013) Biochemistry. 52, 1755-1764]. In order to demonstrate and detail the mechanism of one-third of the sites reactivity of MGST2, we have determined the enzyme oligomeric state, by Blue native PAGE and Differential Scanning Calorimetry, as well as the stoichiometry of substrate and substrate analog inhibitor binding to MGST2, using equilibrium dialysis and Isothermal Titration Calorimetry, respectively. Global simulations were used to fit kinetic data to determine the catalytic mechanism of MGST2 with GSH and CDNB (1-chloro-2,4-dinitrobenzene) as substrates. The best fit was observed with 1/3 of the sites catalysis as compared with a simulation where all three sites were active. In contrast to LTC4S, MGST2 displays a 1/3 the sites reactivity, a mechanism shared with the more distant family member MGST1 and recently suggested also for microsomal prostaglandin E synthase-1.

  9. Spinal epidural abscess: a rare complication of olecranon bursitis. (United States)

    Evans, Rhys D R; Thaya, Moe; Chew, Ne Siang; Gibbons, Charles E R


    Spinal epidural abscess is a rare but potentially fatal condition if left untreated. We report the case of a 67-year old man who presented to the Accident and Emergency department complaining of acute onset of inter-scapular back pain, left leg weakness and loss of sensation in the left foot. On examination he was found to be pyrexial with long tract signs in the left lower leg. In addition he had a left sided olecranon bursitis of three weeks duration. Blood tests revealed raised inflammatory markers and a staphylococcal bacteremia. Magnetic resonance imaging (MRI) confirmed the diagnosis of spinal epidural abscess and he subsequently underwent a three level laminectomy with good resolution of his back pain and neurological symptoms. He has made a complete recovery with a prolonged course of intravenous antibiotics.

  10. Spinal epidural abscess: a rare complication of olecranon bursitis

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    Rhys D.R. Evans


    Full Text Available Spinal epidural abscess is a rare but potentially fatal condition if left untreated. We report the case of a 67-year old man who presented to the Accident and Emergency department complaining of acute onset of inter-scapular back pain, left leg weakness and loss of sensation in the left foot. On examination he was found to be pyrexial with long tract signs in the left lower leg. In addition he had a left sided olecranon bursitis of three weeks duration. Blood tests revealed raised inflammatory markers and a staphylococcal bacteremia. Magnetic resonance imaging (MRI confirmed the diagnosis of spinal epidural abscess and he subsequently underwent a three level laminectomy with good resolution of his back pain and neurological symptoms. He has made a complete recovery with a prolonged course of intravenous antibiotics.

  11. Paecilomyces lilacinus septic olecranon bursitis in an immunocompetent host. (United States)

    Schweitzer, Karl M; Richard, Marc J; Leversedge, Fraser J; Ruch, David S


    Paecilomyces lilacinus is a filamentous fungus that is a rare cause of infection in immunocompromised human hosts. We present a case of lilacinus septic olecranon bursitis in an otherwise healthy 78-year-old male. This patient's case was complicated by wound breakdown after bursectomy and appropriate anti-fungal treatment, requiring a local soft tissue rearrangement. This case demonstrates the need for appropriate and timely medical and surgical treatment in infections involving lilacinus, which are not isolated solely to systemically immunocompromised and medically-ill patient populations. In cases where the patient is systemically immumocompromised or has been rendered locally immunocompromised, it is essential to obtain a full culture work-up, including fungi.

  12. Neglected fracture of the medial humeral epicondyle that was entrapped into the elbow joint: a case report. (United States)

    Potenza, Vito; Farsetti, Pasquale; Caterini, Roberto; Bisicchia, Salvatore; De Luna, Vincenzo; Ippolito, Ernesto


    The objective of this paper is to report clinical and radiographic long-term results of a neglected fracture of the medial humeral epicondyle, which was entrapped into the elbow joint. At follow-up, 48 years after the trauma, the patient complained of occasional discomfort around the elbow, but the joint had a normal range of motion and good stability. Radiographs showed that the epicondylar fragment was fused to the medial border of the olecranon. The authors conclude that an old fracture of the medial humeral epicondyle, presenting a fusion of the fragment to the olecranon with normal range of motion and without pain, may be managed expectantly.

  13. Harvesting bone graft from the olecranon: a quantitative and biomechanical comparison of proximal and dorsal cortical windows. (United States)

    Anderson, Matthew C; Chong, Alexander C M; Lucas, George L; Czuwala, Peter J; Wooley, Paul H


    We conducted a study to compare 2 techniques of harvesting ulna bone graft from the olecranon, one using a proximal cortical window (PCW), the other using a dorsal cortical window (DCW), in terms of cancellous bone graft quantity and ulna fracture strength after graft harvest. Cancellous bone was harvested from 8 pairs of embalmed cadaver proximal ulna. Each side of a matched pair was randomly assigned to graft harvest using either a PCW or a DCW approach. Packed bone volume (PBV) was determined by placing the harvested bone into a 3-mL syringe and compacting it with a quasi-static 25-N load. Biomechanical cantilever bending was performed on each elbow to determine load at failure (LF). Paired Student t tests were used to compare PBV and LF between the experimental and control groups. The graft PBV obtained from the matched-pair specimens was not statistically different between the PCW and DCW approaches. Ulnas subjected to proximal bone harvest exhibited higher LF than ulnas subjected to dorsal bone harvest, though the difference was not statistically significant. Compared with bone graft harvest using the traditional DCW approach, harvest using a PCW approach provides similar cancellous graft amounts and exhibits similar fracture resistance.

  14. Long-term follow-up of corticosteroid injection for traumatic olecranon bursitis. (United States)

    Weinstein, P S; Canoso, J J; Wohlgethan, J R


    Forty-seven patients with traumatic olecranon bursitis were evaluated after a mean follow-up of 31 months (range 6 to 62 months). Twenty-two patients treated with bursal aspiration had delayed recovery and no complications of therapy. Twenty-five patients treated with intrabursal injection of 20 mg of triamcinolone hexacetonide had rapid recovery, usually within one week, but suffered complications such as infection (3 cases), skin atrophy (5 cases), and chronic local pain (7 cases). Since spontaneous resolution can be expected, a conservative approach is suggested in the treatment of traumatic olecranon bursitis. Images PMID:6696516

  15. Desmoplastic fibroma of ulna: Excision and reconstruction of olecranon with a fibular graft

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    Tarun Goyal


    Full Text Available Desmoplastic fibroma is a rare, well differentiated, locally aggressive fibrous tumor usually arising from soft tissues, and rarely from bones. Involvement of forearm bones is extremely unusual. We present a large desmoplastic fibroma of right ulna in a 15-year-old male. The tumor was excised with a wide margin, and the bony defect was reconstructed with nonvascular autologous fibular graft. Reconstruction of the olecranon process was attempted using the fibular head and the remaining olecranon. At 2-years followup, there was no recurrence, flexion extension arc of the elbow joint was 40°-130° and there was no restriction of activities of daily living.

  16. Group B streptococcal meningitis in an adult: A possible complication of olecranon bursitis

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    Manuela Colosimo


    Full Text Available Background: We report a man with septic olecranon bursitis who had an early development of meningitis. Case Summary: A 74-year-old man presented to the emergency room with malaise, headache, mental confusion, a fever unsuccessfully treated with oral NSAIDs and ice, and with a 10-day history of pain and swelling in his right elbow. Clinical and laboratory evaluation excluded other causes and microbiological evaluation documented a S. agalactiae infection. Antibiotic treatment induced a rapid improvement, without the development of side effects. Conclusion: This is the first report on olecranon bursitis and concomitant meningitis related to S. agalactiae infection.

  17. [Fractures of the elbow joint]. (United States)

    Nowak, T E; Dietz, S O; Burkhart, K J; Müller, L P; Rommens, P M


    Fractures around the elbow joint comprise fractures of the distal humerus, the radial head, the olecranon and the coronoid process. Combined lesions are particularly demanding for the surgeon. Accurate knowledge of the anatomy and of the biomechanics is an essential requirement for a specific diagnosis and therapy. A stable and painless movable elbow joint is essential for most of the activities of daily living. Risk factors for the development of posttraumatic elbow joint arthrosis are non-anatomically reconstructed joint surfaces, axial malalignment of the joint axis and untreated concomitant injuries. Modern angular stable and anatomically preshaped implants facilitate a biomechanically adequate osteosynthesis and avoid or decrease functional impairment. In consideration of an increasing number of osteoporotic elbow joint fractures, endoprosthetic replacement has gained significance.

  18. Can China achieve a one-third reduction in premature mortality from non-communicable diseases by 2030? (United States)

    Li, Yichong; Zeng, Xinying; Liu, Jiangmei; Liu, Yunning; Liu, Shiwei; Yin, Peng; Qi, Jinlei; Zhao, Zhenping; Yu, Shicheng; Hu, Yuehua; He, Guangxue; Lopez, Alan D; Gao, George F; Wang, Linhong; Zhou, Maigeng


    The United Nation's Sustainable Development Goals for 2030 include reducing premature mortality from non-communicable diseases (NCDs) by one third. To assess the feasibility of this goal in China, we projected premature mortality in 2030 of NCDs under different risk factor reduction scenarios. We used China results from the Global Burden of Disease Study 2013 as empirical data for projections. Deaths between 1990 and 2013 for cardiovascular disease (CVD), diabetes, chronic respiratory disease, cancer, and other NCDs were extracted, along with population numbers. We disaggregated deaths into parts attributable and unattributable to high systolic blood pressure (SBP), smoking, high body mass index (BMI), high total cholesterol, physical inactivity, and high fasting glucose. Risk factor exposure and deaths by NCD category were projected to 2030. Eight simulated scenarios were also constructed to explore how premature mortality will be affected if the World Health Organization's targets for risk factors reduction are achieved by 2030. If current trends for each risk factor continued to 2030, the total premature deaths from NCDs would increase from 3.11 million to 3.52 million, but the premature mortality rate would decrease by 13.1%. In the combined scenario in which all risk factor reduction targets are achieved, nearly one million deaths among persons 30 to 70 years old due to NCDs would be avoided, and the one-third reduction goal would be achieved for all NCDs combined. More specifically, the goal would be achieved for CVD and chronic respiratory diseases, but not for cancer and diabetes. Reduction in the prevalence of high SBP, smoking, and high BMI played an important role in achieving the goals. Reaching the goal of a one-third reduction in premature mortality from NCDs is possible by 2030 if certain targets for risk factor intervention are reached, but more efforts are required to achieve risk factor reduction.

  19. Prototype partial one-third octave band spectrum analyzer for acoustic, vibration and other wideband data for flight applications (United States)


    The design refinement of a compact frequency analyzer for measurement and analysis on board flight vehicles is discussed. The analyzer has been constructed in a partial one-third octave band configuration with six filters and detectors spaced by the square root of 10 from 316 Hz to 100,000 Hz and a broadband detector channel. The analyzer has been tested over a temperature range of 40 to 120 F at a pressure of one atmosphere, and at a temperature of 75 F at an absolute pressure of 0.000001 torr, and has demonstrated at least 60 db of dynamic range.

  20. Olecranon Bursitis Caused by Candida parapsilosis in a Patient with Rheumatoid Arthritis (United States)

    Rios, Grissel


    Septic bursitis is usually caused by bacterial organisms. However, infectious bursitis caused by fungi is very rare. Herein, we present a 68-year-old woman with long-standing rheumatoid arthritis who developed pain, erythema, and swelling of the right olecranon bursa. Aspiration of the olecranon bursa showed a white blood cell count of 3.1 × 103/μL (41% neutrophils, 30% lymphocytes, and 29% monocytes). Fluid culture was positive for Candida parapsilosis. She was treated with caspofungin 50 mg intravenously daily for 13 days followed by fluconazole 200 mg orally daily for one week. She responded well to this treatment but had recurrent swelling of the bursa. Bursectomy was recommended but she declined this option. This case, together with other reports, suggests that the awareness of uncommon pathogens, their presentation, and predisposing risk factors are important to establish an early diagnosis and prevent long-term complications. PMID:27595032

  1. Olecranon Bursitis Caused by Candida parapsilosis in a Patient with Rheumatoid Arthritis

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    Carla F. Gamarra-Hilburn


    Full Text Available Septic bursitis is usually caused by bacterial organisms. However, infectious bursitis caused by fungi is very rare. Herein, we present a 68-year-old woman with long-standing rheumatoid arthritis who developed pain, erythema, and swelling of the right olecranon bursa. Aspiration of the olecranon bursa showed a white blood cell count of 3.1×103/μL (41% neutrophils, 30% lymphocytes, and 29% monocytes. Fluid culture was positive for Candida parapsilosis. She was treated with caspofungin 50 mg intravenously daily for 13 days followed by fluconazole 200 mg orally daily for one week. She responded well to this treatment but had recurrent swelling of the bursa. Bursectomy was recommended but she declined this option. This case, together with other reports, suggests that the awareness of uncommon pathogens, their presentation, and predisposing risk factors are important to establish an early diagnosis and prevent long-term complications.

  2. Surgical treatment and histopathology of different forms of olecranon and presternal bursitis in cattle and buffalo (United States)

    Fathy, Ahmed


    Thirty seven cases of bursitis presented to our Veterinary Teaching Hospital from 2001 to 2005. There were 10 adult female buffalos with olecranon bursitis (one had bilateral bursitis) and 26 calves (7 cattle and 19 buffalos, 16 males and 10 females) with presternal bursitis. There were 10 out of 11 cases of olecranon bursitis and 21 out of 26 cases of presternal bursitis with different forms (cystic, proliferative and fibrous) that were removed surgically. The remaining 6 cases, cystic bursitis (olecranon = 1, presternal = 5), were treated by aspiration of their contents and injection of 4% iodine tincture intrabursally. Only 2 cases recovered, 3 cases progressed to fibrosis and required further surgical treatment 2 to 3 weeks later, and 1 case continued to have a cystic lesion. Histopathological examination of tissue specimens from different forms of bursitis revealed that the acquired bursae were generally lined with synovial-like membrane formed from 2-3 cellular layers that covered the connective tissue capsule. The connective tissue capsule differed from one type to another and consisted of fibrous tissues containing numerous small blood vessels, blood capillaries, lymphatics and nerves. There was also evidence for inflammation within the capsule represented by congestion of blood vessels and the presence of perivascular inflammatory cells, mostly mononuclear. In conclusion, surgical treatment was successful and effective for treatment of olecranon and presternal bursitis particularly for the chronic proliferative and fibrous form in cattle and buffalo. The histological structure of the acquired bursae was relatively similar consisting of a synovial-like membrane and a connective tissue capsule with varying degrees of the inflammatory process. PMID:16871025

  3. Stress Fracture and Nonunion of Coronoid Process in a Gymnast

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    T. Hetling


    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.

  4. An alternative method of osteosynthesis for distal humeral shaft fractures. (United States)

    Levy, Jonathan C; Kalandiak, Steven P; Hutson, James J; Zych, Gregory


    Treatment of extra-articular distal humerus shaft fractures with plating techniques is often difficult, as traditional centrally located posterior plates often encroach on the olecranon fossa, limiting distal osseous fixation. The use of a modified Synthes Lateral Tibial Head Buttress Plate (Synthes, Paoli, PA) allows for a centrally placed posterior plating of the humeral shaft that angles anatomically along the lateral column to treat far distal humeral shaft fractures. Fifteen patients treated in this manner were followed to radiographic and clinical union. There were no cases of instrumentation failure or loss of reduction.

  5. An Algorithm for Summarization of Paragraph Up to One Third with the Help of Cue Words Comparison

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    Noopur Srivastava


    Full Text Available In the fast growing information era utility of technology are more precise than completing the assignment manually. The digital information technology creates a knowledge-based society with high-tech global economy which spreads over and influence the corporate and service sector to operate in more efficient and convenient way. Here an attempt was made on Extract Technology based on research. In this technology data could be refined and sourced with certainty and relevance. The application of artificial intelligence matched with the theories of machine learning would prove to be very effective. Sometime summarization of paragraph required rather than page or pages. So, Auto Summarization Model is an agnostic content summarization technology that automatically parses news, information, documents and many more into relevant and contextually accurate abbreviated summaries. This is a concept to convert a whole paragraph into one third. The Auto summarization technology reads a document, much better way than manually prepared, where, keywords and key phrases accurately weighted as they are found in the document, text or web page.

  6. [Acetylcysteine in children with lung disorders prescribed by one-third of family physicians: no support in the literature]. (United States)

    Duijvestijn, Y C; Gerritsen, J; Brand, P L


    To determine whether the use of acetylcysteine in children is supported by literature data and to determine how often and for what indications acetylcysteine is prescribed for children in general practice. Systematic literature review and general practitioners audit. Academic Hospital Groningen, the Netherlands. A Medline search was performed and the references of the articles found were checked. All 720 general practitioners working in the three northern provinces of the Netherlands were mailed a questionnaire regarding their prescription of acetylcysteine for children. Of the studies on acetylcysteine in children with pulmonary disorders (excluding cystic fibrosis) (n = 15) the majority (n = 12) were uncontrolled clinical observations. Three clinical trials were found, all of which showed considerable methodological shortcomings. The observed benefit of acetylcysteine therapy in these studies was of no clinical relevance. The questionnaire was filled out completely and returned by 70.3% of general practitioners. Almost one-third of the general practitioners (32.6%) prescribed acetylcysteine now and again for children with various pulmonary disorders (such as 'mucus that is difficult to bring up' (73.9%), asthmatic bronchitis (50.3). bronchitis (40.0%), excessive mucus production (40.0%) and dry cough (34.5%)). Acetylcysteine is being prescribed frequently for children with various pulmonary disorders by general practitioners whilst the use of this drug is not being supported by literature data.

  7. Jaw fractures in children. (United States)

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


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

  8. Ultrasound-Guided 50% Ethyl Alcohol Injection for Patients With Malleolar and Olecranon Bursitis: A Prospective Pilot Study (United States)

    Hong, Ji Seong; Lee, Jin Hyung


    Objective To evaluate the feasibility and effect of ultrasound-guided ethyl alcohol injection on malleolar and olecranon synovial proliferative bursitis. Methods Twenty-four patients received ultrasound-guided 50% diluted ethyl alcohol injection at the site of synovial proliferative bursitis after aspiration of the free fluid. Results Swelling and symptoms significantly decreased in 13 of the 24 patients without any complications. Eleven patients had partial improvement in swelling and symptoms. Conclusion Ultrasound-guided alcohol injection could be an alternative therapeutic option before surgery in patients with chronic intractable malleolar and olecranon synovial proliferative bursitis. PMID:27152282

  9. [Treatment of septic olecranon and patellar bursitis by excision and vacuum-assisted closure therapy]. (United States)

    Walter, G; Kemmerer, M; Hoffmann, R


    Treatment of septic olecranon and patellar bursitis differs considerably and is currently under discussion. We therefore performed a retrospective study of our patients with septic bursitis in the past 5 years. Between March 2007 and February 2012 we treated 79 patients with septic olecranon (n = 43) and patellar (n = 36) bursitis surgically: 61-males, 18 females, age 51 (range: 11-91) years. Four patients had not been treated before, 25 had suffered recurrences after 1-10 previous procedures, and 9 patients had not improved after conservative therapy. 34 patients presented with traumatic rupture or fistula of their bursae. In all cases we performed a radical bursectomy and vacuum-assisted therapy for 4 to 5 days. In addition, patients received systemic antibiotics. We phoned all patients and were successful in 57 cases (72 %). We questioned these patients for range of movement, limitations at work, pain, sensibility disorder, satisfaction with the result and further surgical procedures. In all cases we took tissue specimens for cultures, in 48 preparations histological examination was performed. Microbiological and histological results are discussed in detail. 40 patients were free of complaints, 15 complained of mild pain, 54 of 57 had unlimited range of motion. Minor discomforts at desk work were reported by 5 of 43 patients, 12 out of 36 patient reported discomfort when performing on their knees. There was no recurrence in the period of investigation. We recommend our treatment concept for septic olecranon and patellar bursitis because patient satisfaction is high and recurrences are reliably avoided. The soft tissue is spared, so that plastic covering procedures are seldom necessary. Georg Thieme Verlag KG Stuttgart · New York.

  10. Septic olecranon and prepatellar bursitis in hockey players: a report of three cases. (United States)

    Tuff, Taylor; Chrobak, Karen


    Septic bursitis (SB) is an important differential diagnosis in athletes presenting with an acute subcutaneous swelling of the elbow or knee. Prompt recognition is essential to minimize recovery time and prevent the spread of infection. Due to the significant overlap in clinical features, it is often difficult to differentiate SB from non-septic bursitis (NSB) without bursal aspirate analysis. SB is commonly not considered unless the bursitis is accompanied by a local skin lesion or fever. This study describes two cases of septic olecranon bursitis and one case of septic prepatellar bursitis in adult hockey players presenting to a sports medicine clinic. None of the cases presented with an observable skin lesion and only one case developed a fever. It is therefore essential that clinicians maintain a high index of suspicion and monitor for signs of progression when presented with an acute bursitis even in the absence of these features.

  11. Prepatellar and olecranon bursitis: literature review and development of a treatment algorithm. (United States)

    Baumbach, Sebastian F; Lobo, Christopher M; Badyine, Ilias; Mutschler, Wolf; Kanz, Karl-Georg


    Olecranon bursitis and prepatellar bursitis are common entities, with a minimum annual incidence of 10/100,000, predominantly affecting male patients (80 %) aged 40-60 years. Approximately 1/3 of cases are septic (SB) and 2/3 of cases are non-septic (NSB), with substantial variations in treatment regimens internationally. The aim of the study was the development of a literature review-based treatment algorithm for prepatellar and olecranon bursitis. Following a systematic review of Pubmed, the Cochrane Library, textbooks of emergency medicine and surgery, and a manual reference search, 52 relevant papers were identified. The initial differentiation between SB and NSB was based on clinical presentation, bursal aspirate, and blood sampling analysis. Physical findings suggesting SB were fever >37.8 °C, prebursal temperature difference greater 2.2 °C, and skin lesions. Relevant findings for bursal aspirate were purulent aspirate, fluid-to-serum glucose ratio 3,000 cells/μl, polymorphonuclear cells >50 %, positive Gram staining, and positive culture. General treatment measures for SB and NSB consist of bursal aspiration, NSAIDs, and PRICE. For patients with confirmed NSB and high athletic or occupational demands, intrabursal steroid injection may be performed. In the case of SB, antibiotic therapy should be initiated. Surgical treatment, i.e., incision, drainage, or bursectomy, should be restricted to severe, refractory, or chronic/recurrent cases. The available evidence did not support the central European concept of immediate bursectomy in cases of SB. A conservative treatment regimen should be pursued, following bursal aspirate-based differentiation between SB and NSB.

  12. Surgical management of intercondylar fractures of the humerus using triceps reflecting anconeus pedicle (TRAP approach

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    Pankaj Amite


    Full Text Available Background: Operative fixation of intra-articular fractures of the distal humerus requires adequate exposure. The transolecranon approach is a commonly used approach. The olecranon osteotomy has potential complications related to prominence/migration of hardware, displacement/nonunion of osteotomy and triceps weakness. Triceps-reflecting anconeus pedicle (TRAP approach avoids the olecranon osteotomy without compromising the operative exposure. We present outcome of fixation of displaced intra-articular distal humeral fractures with the use of TRAP approach. Materials and Methods: We reviewed the functional and radiological results of 40 consecutive patients with intercondylar fractures of the humerus treated by internal fixation through TRAP approach. There were 28 males and 12 females and the average age was 32 ± 4.5 years. The right elbow was involved in 27 patients and the left elbow in 13 patients. The mechanism of injury was a fall in 20 patients, a motor-vehicle accident in 16 patients and direct trauma in four patients. Results: At a minimum follow-up of 12 months (average 18 ± 4 months 35 (87.5% patients had good triceps strength. The average range of motion was 118.4 ± 7 degrees (range 80 o -130 o . The average time to union was 3.2 ± 1.6 months (range two to six months. No patient had triceps rupture, implant failure, neurovascular deficit or nonunion. Two patients needed removal of the implant because of subcutaneous prominence. Conclusions: The TRAP approach provides good visualization for fixation of intercondylar fractures of the humerus, without any noticeable untoward effect on triceps strength and postoperative rehabilitation; and one can avoid iatrogenic fracture of the olecranon and its associated complications.

  13. Intramuscular myxoid lipoma in the proximal forearm presenting as an olecranon mass with superficial radial nerve palsy: a case report


    Hildebrand Kevin A; Medlicott Shaun AC; Lewkonia Peter


    Abstract Background Extremity lipomas may occur in any location, including the proximal forearm. We describe a case of a patient with an intramuscular lipoma presenting as an unusual posterior elbow mass. Case presentation We discuss the case of a 57-year-old Caucasian man who presented with a tender, posterior elbow mass initially diagnosed as chronic olecranon bursitis. A minor sensory disturbance in the distribution of the superficial radial nerve was initially thought to be unrelated, but...

  14. Ultrasound-Guided 50% Ethyl Alcohol Injection for Patients With Malleolar and Olecranon Bursitis: A Prospective Pilot Study



    Objective To evaluate the feasibility and effect of ultrasound-guided ethyl alcohol injection on malleolar and olecranon synovial proliferative bursitis. Methods Twenty-four patients received ultrasound-guided 50% diluted ethyl alcohol injection at the site of synovial proliferative bursitis after aspiration of the free fluid. Results Swelling and symptoms significantly decreased in 13 of the 24 patients without any complications. Eleven patients had partial improvement in swelling and sympto...

  15. Mycobacterium avium complex olecranon bursitis resolves without antimicrobials or surgical intervention: A case report and review of the literature (United States)

    Working, Selene; Tyser, Andrew; Levy, Dana


    Introduction Nontuberculous mycobacteria are an uncommon cause of septic olecranon bursitis, though cases have increasingly been described in both immunocompromised and immunocompetent hosts. Guidelines recommend a combination of surgical resection and antimicrobials for treatment. This case is the first reported case of nontuberculous mycobacterial olecranon bursitis that resolved without medical or surgical intervention. Case presentation A 67-year-old female developed a painless, fluctuant swelling of the olecranon bursa following blunt trauma to the elbow. Due to persistent bursal swelling, she underwent three separate therapeutic bursal aspirations, two involving intrabursal steroid injection. After the third aspiration, the bursa became erythematous and severely swollen, and bursal fluid grew Mycobacterium avium complex. Triple-drug antimycobacterial therapy was initiated, but discontinued abruptly due to a rash. Surgery was not performed. The patient was observed off antimicrobials, and gradually clinically improved with a compressive dressing. By 14 months after initial presentation, clinical exam revealed complete resolution of the previously erythematous bursal mass. Discussion This is the first reported case of nontuberculous mycobacterial olecranon bursitis managed successfully without surgery or antimicrobials. Musculoskeletal nontuberculous mycobacterial infections are challenging given the lack of clinical data about optimal duration and choice of antimicrobials or the role of surgery. Additionally, the potential toxicity and drug interactions of antimycobacterials are not insignificant and warrant close monitoring if treatment is pursued. Conclusion This case raises an important clinical question of whether close observation off antimicrobials is appropriate in select cases of immunocompetent patients with localized atypical mycobacterial disease of soft tissue and skeletal structures. PMID:26793457

  16. Intramuscular myxoid lipoma in the proximal forearm presenting as an olecranon mass with superficial radial nerve palsy: a case report

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    Hildebrand Kevin A


    Full Text Available Abstract Background Extremity lipomas may occur in any location, including the proximal forearm. We describe a case of a patient with an intramuscular lipoma presenting as an unusual posterior elbow mass. Case presentation We discuss the case of a 57-year-old Caucasian man who presented with a tender, posterior elbow mass initially diagnosed as chronic olecranon bursitis. A minor sensory disturbance in the distribution of the superficial radial nerve was initially thought to be unrelated, but was likely caused by mass effect from the lipoma. No pre-operative advanced imaging was obtained because the diagnosis was felt to have already been made. At the time of surgery, a fatty mass originating in the volar forearm muscles was found to have breached the dorsal forearm fascia and displaced the olecranon bursa. Tissue diagnosis was made by histopathology as a myxoid lipoma with no aggressive features. Post-operative recovery was uneventful. Conclusion We present a case of an unusual elbow mass presenting with symptoms consistent with chronic olecranon bursitis, a relatively common condition. The only unexplained pre-operative finding was the non-specific finding of a transient superficial radial nerve deficit. We remind clinicians to be cautious when diagnosing soft tissue masses in the extremities when unexplained physical findings are present.

  17. Multiple Fractures of the Elbow%肘部多发性骨折

    Institute of Scientific and Technical Information of China (English)

    孙龙云; 陶仁秀; 翁翔


    Multiple fracture of the elbow refers to fracture of the proximal olecranon associated with compression fracture of the radial head, fracture of the lateral condyle of the humerus, or the medial epicondylc. 31 patients with multiple fractures, confirmed by X-ray werc treated in the years from 1977 to 1984.Their age ranged from 2 to 13.Also discussed are its mechanism, type-grouping and classification.%@@ 肘部多发性骨折系指尺骨鹰咀近端骨折合并桡骨头压缩或肱骨外髁或内上髁骨折.自1977年2月至1984年10月,我们共收治了31例.

  18. Evaluation of impact limiter performance during end-on and slapdown drop tests of a one-third scale model storage/transport cask system

    Energy Technology Data Exchange (ETDEWEB)

    Yoshimura, H.R.; Bronowski, D.R.; Uncapher, W.L.; Attaway, S.W.; Bateman, V.I.; Carne, T.G.; Gregory, D.L. (Sandia National Labs., Albuquerque, NM (USA)); Huerta, M. (Southwest Engineering Associates, El Paso, TX (USA))


    This report describes drop testing of a one-third scale model shipping cask system. Two casks were designed and fabricated by Transnuclear, Inc., to ship spent fuel from the former Nuclear Fuel Services West Valley reprocessing facility in New York to the Idaho National Engineering Laboratory for a long-term spent fuel dry storage demonstration project. As part of the NRC's regulatory certification process, one-third scale model tests were performed to obtain experimental data on impact limiter performance during impact testing. The objectives of the testing program were to (1) obtain deceleration and displacement information for the cask and impact limiter system, (2) obtain dynamic force-displacement data for the impact limiters, (3) verify the integrity of the impact limiter retention system, and (4) examine the crush behavior of the limiters. Two 30-ft (9-m) drop tests were conducted on a mass model of the cask body and scaled balsa and redwood-filled impact limiters. This report describes the results of both tests in terms of measured decelerations, posttest deformation measurements, and the general structural response of the system. 3 refs., 32 figs.

  19. Clinical outcome of one-third-dose depot triptorelin is the same as half-dose depot triptorelin in the long protocol of controlled ovarian stimulation

    Directory of Open Access Journals (Sweden)

    Yu Li


    Full Text Available Objective: Appropriate dosage of the long-acting depot gonadotrophin releasing hormone (GnRH agonist has not been determined in long protocol for IVF, and one-third-dose depot triptorelin was compared with half-dose in a luteal long protocol of in-vitro fertilization/ intra cytoplasmic sperm injection (IVF/ICSI treatment in this study. Materials and Methods: This is a prospective, randomized, open clinical trial. 100 patients were randomized into two groups. Group I received one-third-dose (1.25 mg depot triptorelin. Group II received half-dose (1.87 mg. The clinical and experimental parameters were compared between the two groups. Results: There was no premature luteinizing hormone (LH surge in both groups. On Day 3-5 of menstrual cycle after down-regulation, fewer patients showed low-level LH (<1.0 IU/L and estradiol (<30 pg/mL in group I (P <0.05. There were fewer oocytes retrieved (P =0.086, fewer total embryos and available embryos for cryopreservation in Group I (P <0.05, while good-quality embryo rate was higher in group I (P <0.05. The length and dose of ovarian stimulation was lower in Group I, but not significantly. The clinical pregnancy (52% versus 40%, implantation (48% versus 37.5%, delivery (46% versus 32%, or live birth (42% versus 32% rates and the abortion (8% versus 20% rates showed no significant differences. Conclusion: Depot triptorelin 1.25 mg can be successfully used with reduced pituitary suppression and lower cost in a long protocol for in-vitro fertilization.

  20. A comparison of the simplified olecranon and digital methods of assessment of skeletal maturity during the pubertal growth spurt. (United States)

    Canavese, F; Charles, Y P; Dimeglio, A; Schuller, S; Rousset, M; Samba, A; Pereira, B; Steib, J-P


    Assessment of skeletal age is important in children's orthopaedics. We compared two simplified methods used in the assessment of skeletal age. Both methods have been described previously with one based on the appearance of the epiphysis at the olecranon and the other on the digital epiphyses. We also investigated the influence of assessor experience on applying these two methods. Our investigation was based on the anteroposterior left hand and lateral elbow radiographs of 44 boys (mean: 14.4; 12.4 to 16.1 ) and 78 girls (mean: 13.0; 11.1 to14.9) obtained during the pubertal growth spurt. A total of nine observers examined the radiographs with the observers assigned to three groups based on their experience (experienced, intermediate and novice). These raters were required to determined skeletal ages twice at six-week intervals. The correlation between the two methods was determined per assessment and per observer groups. Interclass correlation coefficients (ICC) evaluated the reproducibility of the two methods. The overall correlation between the two methods was r = 0.83 for boys and r = 0.84 for girls. The correlation was equal between first and second assessment, and between the observer groups (r ≥ 0.82). There was an equally strong ICC for the assessment effect (ICC ≤ 0.4%) and observer effect (ICC ≤ 3%) for each method. There was no significant (p assessing skeletal maturity. The olecranon method offers detailed information during the pubertal growth spurt, while the digital method is as accurate but less detailed, making it more useful after the pubertal growth spurt once the olecranon has ossified. ©2014 The British Editorial Society of Bone & Joint Surgery.

  1. Hindfoot Valgus following Interlocking Nail Treatment for Tibial Diaphysis Fractures: Can the Fibula Be Neglected?

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    Metin Uzun


    Full Text Available Purpose. We evaluated whether intramedullary nail fixation for tibial diaphysis fractures with concomitant fibula fractures (except at the distal one-third level managed conservatively with an associated fibula fracture resulted in ankle deformity and assessed the impact of the ankle deformity on lower extremity function. Methods. Sixty middle one-third tibial shaft fractures with associated fibular fractures, except the distal one-third level, were included in this study. All tibial shaft fractures were anatomically reduced and fixed with interlocking intramedullary nails. Fibular fractures were managed conservatively. Hindfoot alignment was assessed clinically. Tibia and fibular lengths were compared to contralateral measurements using radiographs. Functional results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS and the Foot and Ankle Disability Index Score (FADI. Results. Anatomic union, defined as equal length in operative and contralateral tibias, was achieved in 60 fractures (100%. Fibular shortening was identified in 42 fractures (68%. Mean fibular shortening was 1.2 cm (range, 0.5–2 cm. Clinical exams showed increased hindfoot valgus in 42 fractures (68%. The mean KOOS was 88.4, and the mean FADI score was 90. Conclusion. Fibular fractures in the middle or proximal one-third may need to be stabilized at the time of tibial intramedullary nail fixation to prevent development of hindfoot valgus due to fibular shortening.

  2. One- vs 2-Stage Bursectomy for Septic Olecranon and Prepatellar Bursitis: A Prospective Randomized Trial. (United States)

    Uçkay, Ilker; von Dach, Elodie; Perez, Cédric; Agostinho, Americo; Garnerin, Philippe; Lipsky, Benjamin A; Hoffmeyer, Pierre; Pittet, Didier


    To assess the optimal surgical approach and costs for patients hospitalized with septic bursitis. From May 1, 2011, through December 24, 2014, hospitalized patients with septic bursitis at University of Geneva Hospitals were randomized (1:1) to receive 1- vs 2-stage bursectomy. All the patients received postsurgical oral antibiotic drug therapy for 7 days. Of 164 enrolled patients, 130 had bursitis of the elbow and 34 of the patella. The surgical approach used was 1-stage in 79 patients and 2-stage in 85. Overall, there were 22 treatment failures: 8 of 79 patients (10%) in the 1-stage arm and 14 of 85 (16%) in the 2-stage arm (Pearson χ(2) test; P=.23). Recurrent infection was caused by the same pathogen in 7 patients (4%) and by a different pathogen in 5 (3%). Outcomes were better in the 1- vs 2-stage arm for wound dehiscence for elbow bursitis (1 of 66 vs 9 of 64; Fisher exact test P=.03), median length of hospital stay (4.5 vs 6.0 days), nurses' workload (605 vs 1055 points), and total costs (Sw₣6881 vs Sw₣11,178; all Pbursitis requiring hospital admission, bursectomy with primary closure, together with antibiotic drug therapy for 7 days, was safe, effective, and resource saving. Using a 2-stage approach may be associated with a higher rate of wound dehiscence for olecranon bursitis than the 1-stage approach. Identifier: NCT01406652. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  3. Anterior fracture displacement in Colles’ fractures after Kapandji wiring in women over 59 years (United States)

    Verdonk, René


    The aim of this study was to assess the radiological results of Colles’ fractures treated with Kapandji wiring and to determine the frequency of postoperative anterior fracture displacement. The X-rays of 89 fractures in women over 59 years of age were evaluated. Five weeks after injury, palmar shift of the distal fracture fragments and/or palmar tilt of more than 20° were observed in 26 patients. In ten wrists dorsal tilt was not sufficiently corrected and measured more than 10°. Increase in ulnar variance was more than 2 mm in 37 wrists and more than 5 mm in six wrists; this was more pronounced when the palmar tilt was not corrected properly or when anterior fracture displacement was present. We conclude that Kapandji wiring may not be able to prevent anterior fracture displacement in almost one-third of Colles’ fractures in osteoporotic elderly patients. PMID:16865364

  4. Anterior fracture displacement in Colles' fractures after Kapandji wiring in women over 59 years. (United States)

    Hollevoet, Nadine; Verdonk, René


    The aim of this study was to assess the radiological results of Colles' fractures treated with Kapandji wiring and to determine the frequency of postoperative anterior fracture displacement. The X-rays of 89 fractures in women over 59 years of age were evaluated. Five weeks after injury, palmar shift of the distal fracture fragments and/or palmar tilt of more than 20 degrees were observed in 26 patients. In ten wrists dorsal tilt was not sufficiently corrected and measured more than 10 degrees . Increase in ulnar variance was more than 2 mm in 37 wrists and more than 5 mm in six wrists; this was more pronounced when the palmar tilt was not corrected properly or when anterior fracture displacement was present. We conclude that Kapandji wiring may not be able to prevent anterior fracture displacement in almost one-third of Colles' fractures in osteoporotic elderly patients.


    Institute of Scientific and Technical Information of China (English)


    Objective To evaluate the results of surgery on intercondylar fracture of humerus. Methods Fifty-eight cases (26 males, 32 females), in an average age of 46.6 (13~82 years), of intercondylar fracture of the humerus operated from September 1988 to September 1998 were followed up 29 months (8~63 months). According to the AO /ASIF classification 8, 7 and 5 cases were divided into type B1, B2 and B3 respectively while other 13, 10 and 15 patients into C1, C2 and C3 re spectively. All the cases were evaluated by modified Jupiter assessment. Results Twenty-eight patients gained excellent re suits, while the good, fair and poor outcomes were found in twenty-two, three and five cases respectively. Conclusion Surgical treatment from posterior trans-olecranon approach with combination of internal fixation and bone graft, followed by early active motion and adhesion relief procedure for elbow if necessary, was advocated in intercondylar fracture of humerus.

  6. Association of Ipsilateral Rib Fractures With Displacement of Midshaft Clavicle Fractures. (United States)

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


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

  7. Differences in the prevalence of ankylosing spondylitis in primary and secondary care: only one-third of patients are managed in rheumatology. (United States)

    Dean, Linda E; Macfarlane, Gary J; Jones, Gareth T


    Knowing not only the prevalence of SpA, but also the proportion managed in rheumatology, has implications for health care planning. The aims of this study were to determine the prevalence of SpA and the proportion managed in rheumatology and to examine differences in group characteristics. For the primary care population, we used the Primary Care Clinical Informatics Unit Research (PCCIUR) electronic primary care database, covering one-third of the Scottish population. Patients with AS, and various extraspinal manifestations were identified using Read Codes. For secondary care, we used the Scotland Registry for Ankylosing Spondylitis, which collected data on clinically diagnosed AS patients >15 years of age seen in rheumatology clinics between 2010 and 2013. Prevalence estimate denominators were computed using the adult PCCIUR and Scottish 2011 mid-year population estimates, respectively. Differences in the characteristics of both patient groups were examined using simple descriptive statistics. The prevalence of AS in primary care was 13.4/10 000 (95% CI 12.8, 14.0) and 4.7/10 000 in rheumatology (95% CI 4.5, 4.9). Rheumatology patients were younger overall and at diagnosis (mean age 51 vs 62 years and 35 vs 38, respectively; both P rheumatology. This has important ramifications for health care planning and indicates a large 'silent' proportion of patients who may have serious pathology and would benefit from additional assessment in a specialist clinic. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email:

  8. Study on characteristics of fractures from road traffic accidents in 306 cases

    Institute of Scientific and Technical Information of China (English)

    侯树勋; 章亚东; 吴闻文


    Objective: To investigate the characteristics of bone fractures from road traffic accidents and analyze their injury mechanisms so as to provide reference for the research and medical care of traffic trauma.   Methods: Three hundred and six patients with fractures from road traffic accidents were included into this study. A total of 507 fractures were identified and the injury mechanism, location distribution and frequency were analyzed.   Results: The most common location of fractures was the lower extremities, followed by the upper extremities, skull and maxillofacial region, and the rarest was the spine. A total of 56% of the patients suffered from multiple fractures. The fractures of the patella, femur and pelvis and the fractures of the olecranon, humerus and shoulder often happened simultaneously.   Conclusions: The injury mechanisms can be classified into four types: impact, incoordinate movement, stretch injury and crush and extrusion. The fractures from traffic accidents have the following characteristics: centrifugal distribution of the injuries, multiple fractures, force transmission and ipsilateral occurrence.

  9. A Randomized Trial Among Compression Plus Nonsteroidal Antiinflammatory Drugs, Aspiration, and Aspiration With Steroid Injection for Nonseptic Olecranon Bursitis. (United States)

    Kim, Joon Yub; Chung, Seok Won; Kim, Joo Hak; Jung, Jae Hong; Sung, Gwang Young; Oh, Kyung-Soo; Lee, Jong Soo


    Olecranon bursitis might be a minor problem in the outpatient clinic but relatively be common to occur. However, there are few well-designed studies comparing approaches to treatment. (1) Which treatment (compression bandaging with nonsteroidal antiinflammatory drugs [NSAIDs], aspiration, or aspiration with steroid injections) is associated with the highest likelihood of resolution of nonseptic olecranon bursitis? (2) Which treatment is associated with earliest resolution of symptoms? (3) What factors are associated with treatment failure by 4 weeks? We enrolled 133 patients from two centers; after applying prespecified exclusions (septic bursitis or concomitant inflammatory arthritis, intraarticular elbow pathology, recent aspiration or steroid injection done elsewhere, and refusal to participate), 90 patients were randomly allocated to receive compression bandaging with NSAIDs (C), aspiration (A), or aspiration with steroid injection (AS) groups (30 patients in each). The groups were similar at baseline in terms of age and gender. Seven patients (four from Group A and three from Group AS) were lost to followup. All patients were followed up weekly for 4 weeks, and the same treatment procedure was repeated if the bursitis recurred with any substantial fluid collection. At 4 weeks, the state of resolution and pain visual analog scale (VAS) were evaluated. Failed resolution was defined as presence of persistent olecranon bursal fluid collection at Week 4 after the initiation of the treatment; on the contrary, if bursal fluid collection was clinically reduced or completely disappeared by the end of Week 4, the treatment was considered successful. We compared the proportion of resolution by Week 4 and the median times to resolution among the treatment groups. In addition, we evaluated whether the resolution affected pain VAS and what factors were associated with the resolution. There were no differences in the proportion of patients whose bursitis resolved by Week 4

  10. Double Plating of Distal Fibula Fractures. (United States)

    Vance, Danica D; Vosseller, J Turner


    Distal fibula fractures are common orthopaedic injuries that often require open reduction internal fixation (ORIF) to anatomically reduce the fracture and minimize the risk of posttraumatic arthritis. In certain clinical situations, stouter fixation may be advantageous to decrease the risk of fixation failure. In this study, the authors report on 12 patients who underwent distal fibula ORIF with 2 one-third tubular plates. Twelve consecutive patients who underwent distal fibula ORIF with 2 one-third tubular plates were retrospectively reviewed. Clinical and radiographic outcomes were reviewed, and functional outcomes were obtained using the Foot and Ankle Outcome Score (FAOS). Institutional review board approval was obtained. All 12 fractures healed clinically and radiographically. One patient was lost to follow-up after healing of the fracture. One patient had removal of fibular hardware at 15 months after surgery. Ten patients had no hardware related pain and good ankle function. FAOS scores were obtained at a mean of 25.6 months after surgery and were as follows: pain (87.6, SD = 9.5), activities of daily living (90.4, SD = 14.5), symptoms (93.3, SD = 9.5), sports (89.5, SD = 18.1), and quality of life (57.4, SD = 21.3). Double plating of distal fibula fractures is a viable technique for problem fractures that potentially provides a readily accessible, low-cost alternative to other means of enhancing fixation. Level IV.

  11. Combined fracture dislocation of the navicular bone along with cuboid, cuneiform and longitudinal split fracture of the lateral malleolus: a rare combination of fractures

    Directory of Open Access Journals (Sweden)

    Khatri Chhetri*, Kapil Mani


    Full Text Available Fracture dislocation of the navicular bone, fracture of the cuboid, cuneiform, and longitudinal split fracture of the lateral malleolus is a rare combination of fractures. This is a high velocity injury fracture and can be caused by forcible plantar flexion and inversion of the foot at the time of impact onto the ground. Here we reported such a case in a 35-year-old male patient who was treated by open reduction and fixation with a partially threaded screw and two K-wires for the navicular bone, and two interfragmentary screws with a one third tubular plate for the lateral malleolus. K-wires were removed 6 weeks after surgery followed by partial weight bearing. After 6 months, the patient can walk normally with minimal pain and swelling of the foot. Key words: Arthritis; Navicular fracture dislocation; Split fracture of lateral malleolus

  12. Hip Fracture (United States)

    Diseases and Conditions Hip fracture By Mayo Clinic Staff A hip fracture is a serious injury, with complications that can be life-threatening. The risk of hip fracture rises with age. Older people are at a ...

  13. Case report 355: Delayed closure of the right olecranon epiphysis in a right-handed, tournament-class tennis player (post-traumatic)

    Energy Technology Data Exchange (ETDEWEB)

    Retrum, R.K.; Wepfer, J.F.; Olen, D.W.; Laney, W.H.


    In summary, two cases of delayed union of the ossification center of the ulnar olecranon in the dominant elbow of competitive sibling male tennis players are reported. Pain in the elbow, exaggerated by the serving motion, was the presenting complaint in each patient, and painful, limited, terminal extension of the forearm was the major finding in both patients on physical examination. Radiological studied on the two brothers were virtually identical. In two previously reported cases in the literature, the patients were treated by operative intervention, whereas both young men reported in this manuscript, were treated non-surgically, with subsequent spontaneous fusion of the ossification center of the olecranon in each patient. Thus, such conservative therapy may very well be the treatment of choice. (orig./SHA).

  14. Raynaud's phenomenon and bilateral olecranon bursitis co-existing in a patient with chronic hepatitis B and D treated with pegylated interferon. (United States)

    Arain, Shafique Rehman; Umer, Tahira Perveen


    Pegylated interferon remains the first line treatment for patients with hepatitis D virus and more than one year therapy may be necessary. Interferon a has the most extensive clinical application and is used for the treatment of chronic hepatitis B and D virus as well as HCV infections. The attachment of polyethylene glycol to interferon increases its half-life. Treatment with peg interferon is associated with many troublesome and occasionally with serious or even life-threatening side effects. In this case report, we have described a patient with chronic hepatitis B and D, who developed Raynaud's phenomenon, ischaemic digital necrosis and bilateral olecranon bursitis during Pegylated interferon therapy. The patient underwent a very extensive workup in order to determine the underlying cause of his digital ischaemia and olecranon bursitis, which was finally determined to be secondary to the use of Pegylated interferon.

  15. Olecranon orientation as an indicator of elbow joint angle in the stance phase, and estimation of forelimb posture in extinct quadruped animals. (United States)

    Fujiwara, Shin-Ichi


    Reconstruction of limb posture is a challenging task in assessing functional morphology and biomechanics of extinct tetrapods, mainly because of the wide range of motions possible at each limb joint and because of our poor knowledge of the relationship between posture and musculoskeletal structure, even in the extant taxa. This is especially true for extinct mammals such as the desmostylian taxa Desmostylus and Paleoparadoxia. This study presents a procedure that how the elbow joint angles of extinct quadruped mammals can be inferred from osteological characteristics. A survey of 67 dried skeletons and 113 step cycles of 32 extant genera, representing 25 families and 13 orders, showed that the olecranon of the ulna and the shaft of the humerus were oriented approximately perpendicular to each other during the stance phase. At this angle, the major extensor muscles maximize their torque at the elbow joint. Based on this survey, I suggest that olecranon orientation can be used for inferring the elbow joint angles of quadruped mammals with prominent olecranons, regardless of taxon, body size, and locomotor guild. By estimating the elbow joint angle, it is inferred that Desmostylus would have had more upright forelimbs than Paleoparadoxia, because their elbow joint angles during the stance phase were approximately 165 degrees and 130 degrees , respectively. Difference in elbow joint angles between these two genera suggests possible differences in stance and gait of these two mammals.

  16. Results of Closed Intramedullary Nailing using Talwarkar Square Nail in Adult Forearm Fractures

    Directory of Open Access Journals (Sweden)

    Nadeem A Lil


    Full Text Available The aim of the study was to evaluate results of closed intramedullary nailing using Talwarkar square nails in adult forearm fractures. We prospectively evaluated 34 patients with both bone forearm fractures. The average time to union was 12.8 (SD +3.2 weeks with cast support for a mean of 8.2 weeks. Union was achieved in 31 out of 34 patients. Using the Grace and Eversmann rating system, 17 patients were excellent, 10 were good, and 4 had an acceptable result. Three patients had non-unions, 2 for the radius and one for the ulna. There were two cases of superficial infection, one subject had olecranon bursitis, and one case of radio-ulnar synostosis. Complication rates associated with the use of square nails were lower compared to plate osteosynthesis and locked intramedullary nails. To control rotation post- operatively, there is a need for application of an above-elbow cast after nailing.

  17. Preservation of active range of motion after acute elbow trauma predicts absence of elbow fracture. (United States)

    Darracq, Michael A; Vinson, David R; Panacek, Edward A


    Previous studies indicate that an inability to fully extend the elbow after elbow trauma is indicative of fracture. We hypothesized that maintenance of active range of motion (ROM) of the elbow in flexion, extension, pronation, and supination after elbow trauma is very specific for the absence of fracture or effusion, and limitation of ROM is sensitive for fracture or effusion. This was a prospective observational study with convenience sampling of a carefully selected patient population. This would allow certain types of patients to be excluded from the study. Patients with elbow injury receiving radiographs and meeting enrollment criteria were enrolled between June 2006 and March 2007 at 4 emergency departments in the local region. Demographics, active ROM, and presence of point tenderness at the olecranon, epicondyles, and radial head were recorded by enrolling clinicians. All enrolled patients received standard elbow radiographs. Radiographs were reviewed by blinded radiologists for the presence of fracture and effusion. Sensitivity, specificity, and 95% confidence intervals (CIs) of examination findings were calculated. One hundred thirteen patients were enrolled. Limitation of active ROM was 100% (95% CI, 0.93-1.00) sensitive for fracture or effusion. Preservation of active ROM was 97% (95% CI, 0.89-1.00) specific for the absence of fracture. Point tenderness was also highly sensitive but not specific. Individuals with preservation of active ROM after acute elbow trauma have a very low risk of associated fracture and may not require radiographic studies.

  18. Comparison of contact stresses of the test tyres used by the one third scale model mobile load simulator (MMLS3) and the full-scale test tyres of the Heavy Vehicle Simulator (HVS) - a summary

    CSIR Research Space (South Africa)

    De Beer, Morris


    Full Text Available This paper summarises the results of a study in which the maximum vertical contact stressess of the one third scale test tyres of the Model Mobile Load Simulator (MMLS3) were compared with those measured for three types of full-scale test tyres...

  19. Tratamiento funcional de fracturas desplazadas de olecranon en pacientes mayores de 70 años. [Functional treatment of displaced olecranon fractures in patients older than 70 years old.

    Directory of Open Access Journals (Sweden)

    Gerardo Gallucci


    Full Text Available Objetivo Reportar los resultados clínicos y radiológicos del tratamiento funcional de fracturas desplazadas de olécranon en pacientes >70 años. Material y Métodos Se evaluaron 28 pacientes >70 años con fracturas desplazadas de olécranon. El tratamiento consistió en la inmovilización inicial con una valva de yeso (promedio 5 días y, luego, movilización activa según tolerancia. No se indicó rehabilitación kinesiológica. Ningún paciente fue perdido en el seguimiento. El grupo estaba formado por 27 mujeres y un hombre. La edad promedio era de 82 años. Según la clasificación de la Clínica Mayo, 18 fracturas eran de tipo IIA y 10, de tipo IIB. El seguimiento promedio fue de 14 meses. Resultados La flexo-extensión fue de 142°-15°. La fuerza muscular fue de M5 en 17 pacientes y de M4 en 9. La fuerza de puño fue un 93% del lado contralateral. El dolor según la escala visual analógica fue de 1. La satisfacción con el tratamiento según esta escala fue de 9. Según el puntaje de la Clínica Mayo, 22 pacientes tuvieron resultados excelentes y 6, buenos. El puntaje DASH promedio fue de 15. Veinticuatro pacientes evolucionaron hacia la seudoartrosis. El gap articular final fue, en promedio, de 16 mm. El gap a nivel de la cortical posterior final fue, en promedio de 22 mm. Conclusión El tratamiento no quirúrgico de las fracturas desplazadas de olécranon en pacientes mayores ofrece un nú- mero elevado de buenos resultados funcionales con alto grado de satisfacción. Palabras clave: Fractura de olécranon. Fractura de codo. Tratamiento funcional.

  20. [Atlas fractures]. (United States)

    Schären, S; Jeanneret, B


    Fractures of the atlas account for 1-2% of all vertebral fractures. We divide atlas fractures into 5 groups: isolated fractures of the anterior arch of the atlas, isolated fractures of the posterior arch, combined fractures of the anterior and posterior arch (so-called Jefferson fractures), isolated fractures of the lateral mass and fractures of the transverse process. Isolated fractures of the anterior or posterior arch are benign and are treated conservatively with a soft collar until the neck pain has disappeared. Jefferson fractures are divided into stable and unstable fracture depending on the integrity of the transverse ligament. Stable Jefferson fractures are treated conservatively with good outcome while unstable Jefferson fractures are probably best treated operatively with a posterior atlanto-axial or occipito-axial stabilization and fusion. The authors preferred treatment modality is the immediate open reduction of the dislocated lateral masses combined with a stabilization in the reduced position using a transarticular screw fixation C1/C2 according to Magerl. This has the advantage of saving the atlanto-occipital joints and offering an immediate stability which makes immobilization in an halo or Minerva cast superfluous. In late instabilities C1/2 with incongruency of the lateral masses occurring after primary conservative treatment, an occipito-cervical fusion is indicated. Isolated fractures of the lateral masses are very rare and may, if the lateral mass is totally destroyed, be a reason for an occipito-cervical fusion. Fractures of the transverse processes may be the cause for a thrombosis of the vertebral artery. No treatment is necessary for the fracture itself.

  1. Galeazzi fracture with volar dislocation of the distal radioulnar joint. (United States)

    Kim, Suezie; Ward, James P; Rettig, Michael E


    Galeazzi fracture dislocations are fractures of the distal one-third of the radial diaphysis with traumatic disruption of the distal radioulnar joint (DRUJ). This injury results in subluxation or dislocation of the ulnar head. We present a case of a Galeazzi fracture with a volar dislocation of the DRUJ. Open reduction of the DRUJ with Kirschner wire fixation in pronation was necessary to reduce the joint and maintain anatomic alignment. Repair of the triangular fibrocartilage complex was also necessary to maintain stability of the DRUJ.

  2. Root fractures

    DEFF Research Database (Denmark)

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


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

  3. Is there an association between fractures of the cervical spine and first- and second-rib fractures?

    Energy Technology Data Exchange (ETDEWEB)

    Logan, P.M. [Dalhouse Univ., Dept. of Radiology, Halifax, Nova Scotia (Canada); Queen Elizabeth II Health Science Centre, Victoria General Site, Halifax, Nova Scotia (Canada)


    Objective: To investigate a potential association between cervical spine injury and first- and second-rib fractures. Methods: Retrospective review of the radiologic and medical records of 28 consecutive patients admitted to an acute spinal injury unit. Results: A total of 10 (36%) of the patients with cervical spine trauma also had fractures of either the first or second ribs. Eight of these 10 patients had a fracture or fracture-subluxation of the seventh cervical vertebra or the C6/7 segment. Conclusion: Almost one-third of patients with traumatic cervical spine injury have an associated upper-rib fracture. The strongest association is between injury at the C7 level and first-rib fracture. (author)

  4. Osteosynthesis of Intercondylar Humerus Fracture Using Bryan and Morrey Approach

    Directory of Open Access Journals (Sweden)

    S Lakhey


    Full Text Available INTRODUCTION: The olecranon approach has been the gold standard for surgical approaches to fracture fixation of distal articular surface of humerus. Although it provides a good exposure, it also has disadvantages of delayed union, nonunion and implant related complications at the osteotomy site. OBJECTIVE: The aim of this study was to determine the functional outcome of displaced intra-articular distal humerus fracture fixation using an alternative approach: the Bryan and Morrey approach. MATERIALS AND METHODS: Twenty patients with twenty AO type C1 and C2 intercondylar fractures of the distal humerus had bicolumnar fixationof the distal humerus with two contoured reconstruction plates and screws on the dorsal surface or various combinations of a single reconstruction plate, screws and K-wires using a Bryan and Morrey approach. Twelve of the patients were male and eight were female. The average age of the patients was 44.8 years. Eleven patients had sustained the injury as result of fall and nine of the patients had sustained it in road traffic accidents. Right elbow was involved in fifteen patients and left in five. All patients were followed up for 12 months post operatively. RESULTS: All twenty fractures had united at 4 months follow-up. The mean fixed flexion deformity was 9.0º (range 0º-15º and the mean arc of motion was 115.0 º (range 85 º- 130º. All patients had grade 4 triceps strength and stable elbows at the end of 12 months follow up. One patient had deep seated wound infection resulting in necrosis of the triceps tendon requiring a second operative procedure. CONCLUSIONS: Bryan and Morrey approach is a simpler, easier and better approach as compared to the other posterior approaches to the elbow joint, and therefore, can be used as the approach of choice for fixation of fractures of the distal articular surface of humerus. KEYWORDS: fracture, Humerus, intercondylar, osteosynthesis.

  5. Stress Fractures (United States)

    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 ...

  6. Three-directed traction for extention type of supracondylar fracture of humerus in children%儿童伸直型肱骨髁上骨折的三向牵引治疗

    Institute of Scientific and Technical Information of China (English)

    张敬东; 彭明惺; 索朗; 刘利君; 韦福康; 刘敏; 罗启成


    Objective To evaluate efficacy of three-directed traction ( olecranon skeletal traction on the horizontal, forearm traction on the upwards and humerus traction downwards) for extention type of supracondylar fractures humerus in children. Methods The efficacy and treatment of three-directed traction on 25 cases of extention type of supracondylar fractures of humerus in children were analyzed retrospectively. Results The efficacy was satisfactory in the time of follow-up; All displacements of fractures were be corrected gradually and none replacement in three-directed traction therapy time; Elbow joint function were fine after callus growth through 2 weeks of plaster fixation. Conclusion The three-directed traction is a good method for treatment in extention type of supracondylar fractures of humerus in children. This method is simpleness, credibility and reduction stabilization.

  7. The Role of Computed Tomography in Evaluating Intra-Articular Distal Humerus Fractures. (United States)

    Nolan, Betsy M; Sweet, Stephan J; Ferkel, Eric; Udofia, Aniebet-Abasi; Itamura, John


    Computed tomography (CT) is often used to evaluate intra-articular distal humerus fracture patterns, but it increases radiation exposure and cost. We conducted a study to determine the effect of adding CT evaluation to plain radiographic evaluation on the classification of, and treatment plans for, intra-articular distal humerus fractures. Nine blinded orthopedic surgeons evaluated 30 consecutive fractures for classification and surgical approach. Evaluations were performed first using plain radiographs and then again using the same radiographs plus CT images. Statistical analysis was performed using the κ correlation coefficient and Cramer V testing. We hypothesized that adding CT images to plain radiographs would change the classification and treatment of these fractures and would improve interobserver agreement on classification and treatment. Intraobserver reliability (Cramer V) was fair (.393) for classification and moderate (.426) for treatment. Interobserver reliability (Cohen κ) did not improve with CT: For classification, κ was .21 without CT and .20 with CT; for treatment, κ was .28 without CT and .27 with CT. When classifying the fractures, attending surgeons chose the multiplanar fracture pattern 25.6% of the time without CT, and remained consistent at 23.3% with CT. Trainees chose this fracture pattern much less often without CT than with CT. Use of CT changed the treatment for multiplanar fractures (73.7% lateral approach vs 51.9% posterior approach with olecranon osteotomy). When added to plain radiographic evaluation, CT evaluation changes classification and treatment plans. Interobserver reliability did not improve. Less experienced surgeons were more likely to identify multiplanar fracture patterns with use of CT. We recommend performing CT for all intra-articular distal humerus fractures.

  8. Subharmonic Solutions of Order One-Third (United States)

    Fay, Temple H.


    Finding a periodic solution to a nonlinear ordinary differential equation is in general a difficult task. Only in a very few cases can direct methods be applied to an equation to find initial values leading to a solution of the corresponding initial value problem that is periodic. Oscillatory periodic solutions have such practical importance that…

  9. [Acetabular fractures]. (United States)

    Gänsslen, A; Oestern, H J


    Treatment of acetabular fractures requires extensive knowledge of the bony anatomy, the amount of possible exposure of the bone with the selected approaches and fracture type-dependent indications of operative treatment. Classification of the fracture with detailed analysis of the fracture morphology is the basis for decision making and planning. The primary treatment aim is the anatomic reconstruction of the acetabulum which results in optimal long-term results.The basis of this overview is the presentation of standard treatment concepts in acetabular fracture surgery. Beside characteristics of the acetabular bony anatomy, biomechanical and pathomechanical principles and the relevant radiological anatomy, the treatment options, both conservative and operative and basic principles of the indications for standard surgical approaches will be discussed.The special fracture type is discussed in detail regarding incidence, injury mechanism, concomitant injuries, options for conservative and operative treatment, quality of operative reduction and long-term results.Furthermore, epidemiological data on typical postoperative complications are evaluated.


    Directory of Open Access Journals (Sweden)



    Full Text Available BACKGROUND: Intra-articular distal humeral fractures are common, but complex elbow injuries. To obtain good results, anatomical reduction with rigid fixation and early range of mobilization is required. Treatment of these fractures with conventional plates is associated with many complications such as non-anatomic reduction of articular surfaces, malunion, non-union, loosening of implant, residual stiffness of the elbow and post-traumatic osteoarthrosis. In this situation the application of locking plates having a fixed angle plate screw construct can minimise most of the above complications. OBJECTIVE: To evaluate radiological and functional outcome of locking plate application for the management of intra-articular distal humeral fractures. MATERIAL AND METHODS: This prospective study was conducted from January 2013 to December 2014. We operated 20 patients of AO type-C intra-articular distal humeral fractures. Fracture was exposed using modified Campbell’s posterior approach in less comminuted fractures and a V-shaped Olecranon osteotomy was done to get better exposure of the articular surface in cases with severe articular comminution. The fracture was stabilized using an intercondylar screw, pre-contoured locking compression plates and/or locking reconstruction plates as per preoperative planning. Patients were reviewed at monthly interval for clinical-radiological evaluation. Final outcome measures included radiological assessment, range of motion and Mayo elbow performance score (MEPS. RESULTS: All the fractures were united at an average 12 weeks. Two patients developed numbness in the distribution of ulnar nerve and one patient developed superficial infection in immediate postoperative period. None of the patients had malunion and loosening of implant. The average arc of flexion-extension was 105`, although no patient had loss of supination/pronation. Mayo Elbow Performance Score was excellent in 15 (75%, good in 3 (15%, fair in 1 (5

  11. Sports fractures.


    DeCoster, T. A.; Stevens, M. A.; Albright, J. P.


    Fractures occur in athletes and dramatically influence performance during competitive and recreational activities. Fractures occur in athletes as the result of repetitive stress, acute sports-related trauma and trauma outside of athletics. The literature provides general guidelines for treatment as well as a variety of statistics on the epidemiology of fractures by sport and level of participation. Athletes are healthy and motivated patients, and have high expectations regarding their level o...

  12. Infectious olecranon and patellar bursitis: short-course adjuvant antibiotic therapy is not a risk factor for recurrence in adult hospitalized patients. (United States)

    Perez, Cédric; Huttner, Angela; Assal, Mathieu; Bernard, Louis; Lew, Daniel; Hoffmeyer, Pierre; Uçkay, Ilker


    No evidence-based recommendations exist for the management of infectious bursitis. We examined epidemiology and risk factors for recurrence of septic bursitis. Specifically, we compared outcome in patients receiving bursectomy plus short-course adjuvant antibiotic therapy (7 days). Retrospective study of adult patients with infectious olecranon and patellar bursitis requiring hospitalization at Geneva University Hospital from January 1996 to March 2009. We identified 343 episodes of infectious bursitis (237 olecranon and 106 patellar). Staphylococcus aureus predominated among the 256 cases with an identifiable pathogen (85%). Three hundred and twelve cases (91%) were treated surgically; 142 (41%) with one-stage bursectomy and closure and 146 with two-stage bursectomy. All received antibiotics for a median duration of 13 days with a median intravenous component of 3 days. Cure was achieved in 293 (85%) episodes. Total duration of antibiotic therapy [odds ratio (OR) 0.9; 95% confidence interval (95% CI) 0.8-1.1] showed no association with cure. In multivariate analysis, only immunosuppression was linked to recurrence (OR 5.6; 95% CI 1.9-18.4). Compared with 14 days of antibiotic treatment (OR 0.9; 95% CI 0.1-10.7) was equivalent, as was the intravenous component (OR 1.1; 95% CI 1.0-1.3). In severe infectious bursitis requiring hospitalization, adjuvant antibiotic therapy might be limited to 7 days in non-immunosuppressed patients.

  13. Treating36 cases of olecranon bursitis in the integrative medicine%中西医结合治疗尺骨鹰嘴滑囊炎36例

    Institute of Scientific and Technical Information of China (English)



    Objective: To observe clinical effects of the integrative medicine on olecranon bursitis. Methods: 18 cases in the observed group were treated by fire needle plus western medicine. 18 cases in the control group received conventional partial closure. Results: The total efifciency in the observed group was 88.89%, higher than 83.33% in the control group, with a signiifcantly statistical difference (P<0.05). Conclusion: The integrative medicine was obviously effective on olecranon bursitis, and showed a good clinical value.%目的:观察火针结合西药内服治疗尺骨鹰嘴滑囊炎的疗效。方法:观察组18例采用火针结合西药内服治疗,对照组18例采用常规局部封闭治疗。结果:观察组总有效率为88.89%,高于对照组的83.33%,观察组与对照组比较,差异有统计学意义(P<0.05)。结论:中西医结合治疗尺骨鹰嘴滑囊炎效果显著,具有较好的临床应用价值。

  14. Hamate fractures. (United States)

    Sarabia Condés, J M; Ibañez Martínez, L; Sánchez Carrasco, M A; Carrillo Julia, F J; Salmerón Martínez, E L


    The purpose of this paper is to present our experience in the treatment of the fractures of the hamate and to make a review of the literature on this topic. We retrospectively reviewed 10 patients treated in our clinic between 2005-2012 suffering from fractures of the hamate. Six cases were fractures of the body and four were fractures of the hamate. Five cases were of associated injuries. Diagnostic delay ranged from 30 days to 2 years. Patient follow-up ranged from 1 to 10 years. Patient satisfaction was evaluated using the DASH questionnaire. Five patients with a fracture of the body underwent surgery, and one was treated conservatively. Two patients with fracture of the hook of the hamate were treated with immobilization, and two more patients had the fragment removed. The grip strength and the digital clip were reduced in 2 cases. Flexion and extension of the wrist was limited in 3 cases. The mobility of the fingers was normal in all the cases, except in one. The results obtained from the DASH questionnaire were normal in all the cases, except in one case of fracture of the hamate, and in two cases of fracture of the body. The surgical treatment should reduce the dislocation and stabilize the injuries with osteosynthesis. The fractures of the hamate are usually diagnosed late, and the most recommended treatment is removal of the fragment, although it cannot be deduced from this study. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  15. Colles Fracture


    Sánchez León, Belisario; Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú


    Our expertise is the study of more than 2,000 cases of Colles' fractures. Colles name should in this case to synthesize the type of fractures of the lower end of the radius. There have been various proposed classifications according to the different fracture lines can be demonstrated radiologically in the region of the wrist. We believe that these ratings should only be retained if the concept of the articular fracture or not in the classical sense, since it has great value in the functional ...

  16. [Case report and literature review: elbow fracture dislocation in children]. (United States)

    Guzmdn, R; Rincón, D; Camacho, J


    Elbow dislocation in children is a very infrequent traumatic event which was first described by Stimson in 1900 and then by Tachdjian in 1990. Its estimated incidence ranges from 3% to 6% of all elbow injuries, peaking at 13-14 years. Elbow trauma is classified considering the direction in which the proximal radioulnar joint shifts with respect to the humerus, into posterior and anterior dislocation. The former is the most frequent and accounts for 95% of cases. Elbow fracture dislocation is an even rarer event. The incidence rate of avulsion fracture of the medial epicondyle is 25-36%, of the lateral condyle 4%, of the olecranon 1.7%, of the radial head 8%, of the coronoid process 3.5%, and others, 3.5%. At present there is no consensus in the literature on how to treat this type of lesions, particularly because some authors advocate nonsurgical management, while others propose surgical management as the definitive treatment. What is clear, however, is that a late diagnosis or untimely treatment may affect the child's growth and lead to serious complications. The purpose of this study is to share our experience and good results with the surgical management of these infrequent cases.

  17. Minimally invasive plate osteosynthesis for humerus diaphyseal fractures

    Directory of Open Access Journals (Sweden)

    M Shantharam Shetty


    Full Text Available Background: Minimally invasive plate osteosynthesis (MIPO technique is reported as a satisfactory procedure for the treatment of humeral shaft fractures by the anterior approach by several authors. However, none of the published reports had a significant follow-up nor have they reported patient outcomes. We evaluated the clinical, radiographic, and functional outcome over a minimum follow-up of 2 years using the same MIPO technique to humeral shaft fracture. Materials and Methods: 32 adult patients with diaphyseal fractures of the humerus treated with MIPO between June 2007 and October 2008 were included in the study. Patients with metabolic bone disease, polytrauma, and Gustilo and Anderson type 3 open fractures with injury severity score >16 were excluded from the study. All cases were treated with closed indirect reduction and locking plate fixation using the MIPO technique. The surgery time, radiation exposure, and time for union was noted. The shoulder and elbow function was assessed using the UCLA shoulder and Mayo elbow performance scores, respectively. Results: Of the 32 patients in the study, 19 were males and 13 were females. The mean age was 39 years (range: 22-70 years. Twenty-seven of the thirty-two patients (84.3% had the dominant side fractured. We had eight cases of C2 type; five cases of C1 and A2 type; four cases of B2 type; three cases each of B3, B1, and A1 type; and one case of A3 type of fracture. The mean surgical time was 91.5 minutes (range: 70-120 minutes and mean radiation exposure was 160.3 seconds (range: 100-220 seconds. The mean radiological fracture union time was 12.9 weeks (range: 10-20 weeks. Shoulder function was excellent in 27 cases (84.3% and good in remaining 5 cases (15.6% on the UCLA score. Elbow function was excellent in 26 cases (81.2%, good in 5 cases (15.6%, and fair in 1 case (3.1% who had an associated olecranon fracture that was fixed by tension band wire in the same sitting. Conclusion: MIPO of

  18. Fracture Mechanics

    CERN Document Server

    Zehnder, Alan T


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

  19. Open Reduction and Internal Fixation of a Fracture-dislocation of the Ankle

    Directory of Open Access Journals (Sweden)

    Yaniel Truffin Rodriguez


    Full Text Available Open reduction and internal fixation of the fracture-dislocation of the ankle with plates, screws and Kirschner wires is a well-defined treatment method. This paper presents the management of a fracture-dislocation of the right ankle in a 33-year-old female patient stabilized by using a one-third tubular plate, screws, and Kirschner wires with tension-band wires. Results were satisfactory.

  20. Geriatric Intervention in Elderly Patients with Hip Fracture in an Orthopaedic Ward

    DEFF Research Database (Denmark)

    Gregersen, Merete; Damsgaard, Else Marie Skjøde; Hougaard, Kjeld


    Introduction: Hip fracture is a common cause of long hospital stay in the elderly. Approximately one third of these patients die within the first year. As a consequence geriatric and orthopedic col-laboration (orthogeriatrics) has been organized in different ways. The aim of this study is to eva-...

  1. Fracture mechanics

    CERN Document Server

    Perez, Nestor


    The second edition of this textbook includes a refined presentation of concepts in each chapter, additional examples; new problems and sections, such as conformal mapping and mechanical behavior of wood; while retaining all the features of the original book. The material included in this book is based upon the development of analytical and numerical procedures pertinent to particular fields of linear elastic fracture mechanics (LEFM) and plastic fracture mechanics (PFM), including mixed-mode-loading interaction. The mathematical approach undertaken herein is coupled with a brief review of several fracture theories available in cited references, along with many color images and figures. Dynamic fracture mechanics is included through the field of fatigue and Charpy impact testing. Explains computational and engineering approaches for solving crack-related problems using straightforward mathematics that facilitate comprehension of the physical meaning of crack growth processes; Expands computational understandin...

  2. Fracture mechanics (United States)

    Shannon, John L., Jr.


    The application of fracture mechanics to the design of ceramic structures will require the precise measurement of crack growth and fracture resistance of these materials over their entire range of anticipated service temperatures and standardized test methods for making such measurements. The development of a standard test for measuring the plane strain fracture toughness is sought. Stress intensity factor coefficients were determined for three varieties of chevron-notch specimens, and fracture toughness measurements were made on silicon nitrides, silicon carbides, and aluminum oxides to assess the performance of each specimen variety. It was determined that silicon nitride and silicon carbides have flat crack growth resistance curves, but aluminum oxide does not. Additionally, batch-to-batch differences were noticed for the aluminum oxide. Experiments are continuing to explain the rising crack growth resistance and batch-to-batch variations for the aluminum oxide.

  3. Posterior acetabular column and quadrilateral plate fractures: fixation with tension band principles. (United States)

    Aly, Tarek A; Hamed, Hany


    Acetabular fractures can be classified into 5 simple and 5 associated fracture patterns. A significant amount of variation and complexity exists in these fractures patterns. Fractures of the posterior wall are the most common acetabular fractures. Comminution of the quadrilateral plate adds to fracture instability, and more rigid and stable internal fixation is mandatory. The goal of this study was to assess the results of reconstruction of comminuted posterior wall fractures of the acetabulum associated with quadrilateral plate fractures using the tension band technique. Twelve patients (9 men and 3 women) were included in the study. Mean patient age was 38.6 years (range, 24-47 years). Minimum follow-up was more than 2 years postoperatively. Reconstruction of the fracture included anatomic reduction of the fracture and fixation with a buttress plate for the posterior column and a prebent one-third tubular plate for the quadrilateral plate fracture. Clinical results were excellent in 58% of patients and good in 17% of patients. Radiologic results were excellent in 50% of patients and good in 17% of patients. Radiologically, based on the fracture gap postoperatively, 8 (66%) patients showed anatomic reduction, 2 (17%) showed good reduction, and 2 (17%) showed poor reduction. The study confirms that this method of reconstruction facilitates accurate and firm reduction of displaced posterior wall fractures of the acetabulum.

  4. Fracture strength of the remaining dental structure after different cavity preparation designs. (United States)

    Teixeira, Evisabel Siqueira Simões; Rizzante, Fabio Antonio Piola; Ishikiriama, Sérgio Kiyoshi; Mondelli, José; Furuse, Adilson Yoshio; Mondelli, Rafael Francisco Lia; Bombonatti, Juliana Fraga Soares


    The aim of this in vitro study was to evaluate the loss of tooth structure after cavity preparation for direct (retentive) and indirect (nonretentive) restorations and its relationship to the fracture strength of the prepared tooth. Sound human third molars (60 maxillary and 60 mandibular) were randomly assigned into 12 groups (n = 10) according to the type of cavity preparation and the respective buccolingual width. Class II mesio-occlusodistal cavity preparations, for both indirect inlay and direct resin restorations, were prepared with standardized dimensions of one-half, one-third, or one-quarter of the occlusal intercuspal distance. Fracture resistance was lower and weight loss was greater for all nonretentive preparations. Greater losses in weight and fracture resistance occurred when the buccolingual width for both types of cavities increased, except for the weight loss of the one-quarter and one-third indirect cavity preparations in the mandibular molars, and the fracture resistance of the one-half and one-third direct cavity preparations in maxillary molars. Higher tooth structure loss and lower fracture strength were recorded after preparation of the inlay cavities.

  5. Galeazzi fracture. (United States)

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


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

  6. Fracture Blisters

    Directory of Open Access Journals (Sweden)

    Uebbing, Claire M


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

  7. Hand Fractures (United States)

    ... Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is ... serve as a framework. This framework supports the muscles that make the wrist ... When one of these hand bones is broken (fractured), it can prevent you ...

  8. Fracture source

    Directory of Open Access Journals (Sweden)


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

  9. Rib Fractures (United States)

    ... Commentary Recent News Scientists Working on Solar-Powered Prosthetic Limbs Exercise a Great Prescription to Help Older Hearts Bavencio Approved for Rare Skin Cancer Older Mothers May Raise Better-Behaved Kids, Study ... or a collapsed lung (pneumothorax—see Traumatic Pneumothorax ). An injury that fractures the lower ribs sometimes also damages the liver (see Liver ...

  10. [Thoracolumbar fractures]. (United States)

    Freslon, M; Bouaka, D; Coipeau, P; Defossez, G; Leclercq, N; Nebout, J; Marteau, E; Poilbout, N; Prebet, R


    Thoracolumbar fractures are frequent and the functional outcomes are sometimes severe. This multicentric study, including five medical centers, was performed to evaluate the long-term outcomes of the patients. One hundred and thirty six patients with thoracolumbar fracture (T11 to L2) was evaluated with a minimal follow-up of two years. Every one had a clinical exam with a score of Oswestry and an X-Ray study (before and after treatment and at revision). Most of them presented compression fractures, the most often at L1 level. On X-rays, a gain was noted on the vertebral kyphosis immediately after surgery, but there is a loss of correction over time whatever the treatment. The clinical outcomes for the patients were great, with an Oswestry average score of 6,4. A correlation was noted between this functional score and vertebral kyphosis. So, an anterior column strengthening (isolated or performed during the surgery) could improve these functional outcomes. Moreover, the Thoraco Lumbar Injury Severity Score (TLISS) seems to be a simple organigram to determine the most appropriate treatment of these fractures, with particular attention to the distraction mechanism or posterior ligamentous complex lesions. However, RMI before surgery is necessary to evaluate these lesions.

  11. Functional Results of Intercondylar Fractures of the Humerus Fixed with Dual Y-Plate; A Technical Note

    Directory of Open Access Journals (Sweden)

    Swagat Mahapatra


    Full Text Available Objective: To evaluate and report the functional results of surgical management of intercondylar fractures of the humerus in adults using a novel dual plating technique. Methods: A total number of 60 patients with Riseborough and Radin type II, III, and IV intercondylar humerus fractures were operated with open reduction through a Trans-olecranon approach and internal fixation using two plates in inverted-Y configuration. Patients were followed for 3 weeks, 3 and 6 months were evaluated using the Mayo Elbow performance score and Quick-DASH score. Results: There were 50(83.33%men and 10 (16.67%women with mean age of 34.9 ± 12.63 years. 63.3% of the cases were following Motor vehicle accident and rest following fall. The right upper limb was more commonly affected than the left side. Riseborough and Radin type II fractures accounted for 3.33% of cases; type III fractures accounted for 50% of cases and type IV accounted for 46.67%. Excellent to Good results were seen in almost 80% of cases as per the Mayo Elbow performance score at 6-month follow-up. Quick-DASH scores for the series at 6-month follow-up was on average of 15.96 ± 9.92. Conclusion: Dual plating in inverted Y configuration offers a reliable fixation, which permits early mobilization and good functional outcome.

  12. Functional Results of Intercondylar Fractures of the Humerus Fixed with Dual Y-Plate; A Technical Note (United States)

    Mahapatra, Swagat; Abraham, Vineet Thomas


    Objective: To evaluate and report the functional results of surgical management of intercondylar fractures of the humerus in adults using a novel dual plating technique. Methods: A total number of 60 patients with Riseborough and Radin type II, III, and IV intercondylar humerus fractures were operated with open reduction through a Trans-olecranon approach and internal fixation using two plates in inverted-Y configuration. Patients were followed for 3 weeks, 3 and 6 months were evaluated using the Mayo Elbow performance score and Quick-DASH score. Results: There were 50(83.33%)men and 10 (16.67%)women with mean age of 34.9 ± 12.63 years. 63.3% of the cases were following Motor vehicle accident and rest following fall. The right upper limb was more commonly affected than the left side. Riseborough and Radin type II fractures accounted for 3.33% of cases; type III fractures accounted for 50% of cases and type IV accounted for 46.67%. Excellent to Good results were seen in almost 80% of cases as per the Mayo Elbow performance score at 6-month follow-up. Quick-DASH scores for the series at 6-month follow-up was on average of 15.96 ± 9.92. Conclusion: Dual plating in inverted Y configuration offers a reliable fixation, which permits early mobilization and good functional outcome.

  13. Long-term response to gluten-free diet as evidence for non-celiac wheat sensitivity in one third of patients with diarrhea-dominant and mixed-type irritable bowel syndrome. (United States)

    Barmeyer, Christian; Schumann, Michael; Meyer, Tim; Zielinski, Christina; Zuberbier, Torsten; Siegmund, Britta; Schulzke, Jörg-Dieter; Daum, Severin; Ullrich, Reiner


    Irritable bowel syndrome (IBS) is common but therapies are unsatisfactory. Food is often suspected as cause by patients, but diagnostic procedures, apart from allergy testing, are limited. Based on the hypothesis of non-celiac wheat sensitivity (WS) in a subgroup of IBS patients, we tested the long-term response to a gluten-free diet (GFD) and investigated HLA-DQ2 or -DQ8 expression as a diagnostic marker for WS in diarrhea-dominant (IBS-D) and mixed-type IBS (IBS-M). The response to a GFD served as reference test for WS and HLA-DQ2/8 expression was determined as index test. Patients were classified as responders if they reported complete or considerable relief of IBS symptoms on at least 75 % of weeks over a 4-month period of gluten-free diet. Established questionnaires (IBS-Quality of Life (IBS-QoL), IBS Symptom Severity Scale (IBS-SSS), European Quality of Life-5 Dimensions (EQ-5D)) were used for secondary outcome measures. Thirty-five patients finished the study. Of these, 12 (34 %) were responders and classified as having WS (95 % CI 21-51 %). HLA-DQ2/8 expression had a specificity of 52 % (95 % CI 33-71 %) and sensitivity of 25 % (95 % CI 8-54 %) for WS. Responders showed improvement in quality of life and symptom scores. At 1-year follow-up, all responders and 55 % of non-responders were still on GFD and reported symptom relief. Using strict criteria as recommended for IBS studies, about one third of patients with IBS-D or IBS-M are wheat sensitive, with a similar proportion in both IBS types. Expression of HLA-DQ2/8 is not useful as diagnostic marker for WS. Long-term adherence to a GFD is high and can sustain symptomatic improvement.

  14. BRCA1 1675delA and 1135insA Account for One Third of Norwegian Familial Breast-Ovarian Cancer and Are Associated with Later Disease Onset than Less Frequent Mutations

    Directory of Open Access Journals (Sweden)

    Åke Borg


    Full Text Available A total of 845 women from breast-ovarian cancer kindreds were enrolled in a clinical follow-up program for early disease diagnosis; 35 women were prospectively identified with cancer. In order to estimate the role of genetic factors for cancer predisposition in this well-defined set of patients, considered as representative for familial breast-ovarian cancer in the Norwegian population, the BRCA1 gene was investigated for germline mutations. The entire coding region of BRCA1 was analysed using a protein truncation test, direct sequencing and a screen for known large genomic deletions and insertions. Twenty one (60% of the 35 patients were identified as carriers of 11 distinct BRCA1 mutations. Two previously described founder mutations, 1675delA and 1135insA, were found to account for more than half (11/21 of all BRCA1 cases and for almost one third (11/35 of all breast and ovarian cancers. Supported by a previous population-based analysis of these founder mutations in ovarian cancer, our findings suggest that a significant proportion of women at risk for developing inherited breast and ovarian cancer can be identified. This is particularly obvious in certain geographic regions where these founder mutations are prevalent. Women carrying the two founder mutations had a significantly older age of disease onset as compared to women with other BRCA1 mutations. This observation indicates that BRCA mutation penetrance estimates from populations with strong founder effects may be biased. One reason why some deleterious mutations are allowed to prevail in a population may be coupled to penetrance and the fact that they seldom induce disease in women in child-bearing ages. Eleven out of 12 (92% breast cancers in BRCA1 mutation carriers were estrogen receptor negative, versus 4 out of 9 (44% in mutation negative patients (p = 0.03. Histopathological characteristics of the prospectively detected cancers indicated an unfavourable prognosis in mutation

  15. Controversies in the management of intra-articular fractures of distal humerus in adults

    Directory of Open Access Journals (Sweden)

    Sudhir Babhulkar


    Full Text Available Background: The surgical approach, type of olecranon osteotomy, method of stabilization of osteotomy, type of fracture stabilization, orthogonal vs parallel plate fixation, need for transposition of ulnar nerve, place for primary total elbow replacement, and type of rehabilitation schedule after surgical fracture treatment are the controversial issues in the treatment of complex intra-articular distal humerus fractures (C2 and C3 in adults. Severe comminution, bone loss, and osteoporosis at the site of distal articular fractures of humerus often lead to unsatisfactory results due to inadequate fixation. We hereby report the outcome of a series of intracondylar fractures of the humerus treated by open reduction and internal fixation and discuss the controversies in light of published literature. Materials and Methods: One hundred and eighty-four patients of intra-articular fractures of distal humerus (C2 and C3 were operated by posterior transolecranon approach between January 1980 and December 2008. Initially, in the first part Chevron intra-articular osteotomy (n=108 was performed out of which 94 have been published in another publication. In later second part (1993 onward, extra-articular olecranon osteotomy (n=76 was routinely performed. Both columns were stably fixed by orthogonal methods; (n=174 however, during the last 2 years, in 10 patients with severe comminution with bone loss, stabilization was achieved by parallel plating. The osteotomy was routinely stabilized by tension band wiring with two parallel K-wires introduced up to the anterior ulnar cortex. The results were evaluated by the staging system of Caja et al. at a minimum follow-up of 2 years. Results: In the first part of the study (n=94, there was delayed union in 4% (n=4, with the fracture taking more than 20 weeks for union. There was delayed union of ulnar osteotomy (n=3 and failure of one tension band wiring, requiring revision. Some loss of motion was seen in 20% of


    Directory of Open Access Journals (Sweden)



    Full Text Available The cases of twenty two fractures of the ankle joint that involved the tibial plafond were reviewed. The fractures were classified in to five types according to the severity of the injury. Open reduction and internal fixation was performed using one third tubular plate for fibula and recon plate for the tibia. Bone grafting was don e to augment the fixation and maintain the reduction . For each fracture treated Objective and Subjective evaluation is done. The objective and subjective scores are compared. With this method we noticed that the Type III & IV fractures also had a good or e xcellent result .

  17. Growth Plate Fractures (United States)

    ... the most widely used by doctors is the Salter-Harris system, described below. Type I Fractures These ... incidence of growth plate fractures peaks in adolescence. Salter-Harris classification of growth plate fractures. AAOS does ...

  18. Chopart fractures. (United States)

    Klaue, Kaj


    The Chopart articular space was described by François Chopart (1743-1795) as a practical space for amputations in cases of distal foot necrosis. It corresponds to the limit between the anatomical hind-foot and the mid-foot. The bones involved are the talus and the calcaneus proximally, and the navicular and the cuboid distally. This space thus holds two functionally distinct entities, the anterior part of the coxa pedis (an essential functional joint) and the calcaneo-cuboidal joint,which can be considered to be an "adaptive joint" within a normal foot. Trauma to this region may cause fractures and/or dislocations and, in high energy trauma,compartment syndromes. Principles of treatment are immediate reduction of dislocations and realignment of the medial and lateral column of the foot in length and orientation. Open reduction and internal fixation of talus and navicular fractures are often indicated to restore the "coxa pedis". Open reconstruction or fusion in correct length of the calcaneo-cuboidal joint is occasionally indicated. Salvage procedures in malunions include navicular osteotomies and calcaneo-cuboidal bone block fusions. Treatment of joint destructions, especially involving the talo-navicular joint, include triple arthrodesis.

  19. Fractures of the distal radius (Colles' fracture)

    National Research Council Canada - National Science Library

    João Carlos Belloti; João Baptista Gomes dos Santos; Álvaro Nagib Atallah; Walter Manna Albertoni; Flavio Faloppa


    CONTEXT AND OBJECTIVE: Although Colles' fracture is a common clinical situation for the orthopedist, we did not find any information in the literature that would allow safe decision-making on the best treatment for each fracture type...

  20. [Problems in osteosynthesis of patella fractures with the AO tension belt and consequences for new implants. The XS nail]. (United States)

    Gehr, J; Friedl, W


    The eccentric ventral AO tension belt system represents the standard therapy of fractures of the patella. This often leads to unsatisfying results. Relating to Klute and Meenen [10] and the results of our own retrospective study, expressed as a percentage, 5-34% (own results 12.4%) have extremely poor treatment outcome, 23-60% (39%) end in deficiencies of bending, and there are 51-79.5% (65.7%) with subjective complaints after patella osteosynthesis. The disadvantages due to the eccentric tension belt position and the impossibility of applying the tension belt directly to the bone surface are abolished with the development of the XS nail. Due to its central position, constant compression of the entire fracture surface is provided. This is valid for all tension-stressed fractures such as those of the patella and olecranon. In synthetic patellae [5] standardized stress testing with changing tension up to 500 Newton was carried out. The XS nail was compared with the AO tension belt osteosynthesis after osteotomy and osteosynthesis in synthetic patellae. The XS nail was superior to the tension belt for all tests and therefore can be applied to all types of fractures where tension stress exists. We repaired the first 15 patella fractures with the XS nail. In 13 of 15 cases, full load of the injured leg was possible (for stairs a plaster splint was used). The experimental patella tests and first clinical results with the XS nail osteosynthesis after patella fracture confirm the new type of osteosynthesis, and functional treatment with loading seems possible.

  1. 双钢板内固定治疗肱骨远端粉碎性骨折%Treatment of distal humerus extremity comminuted fracture by internal fixation with double plates

    Institute of Scientific and Technical Information of China (English)

    游逸丰; 潘建成; 王慧; 周佩敏


    Objective To evaluate the effect of the distal humerus extremity comminuted fracture treated by double plates through oleeranon osteotomy. Method Twenty-eight patients with humerus extremity comminuted fractures were fixed by double plates through olecranon osteotomy followed by early functional exercise. Results All the cases were followed up 9-31 months. The curative effect was assessed by the method of modified Cassebaum rating system. The operation was excellent in 10 cases, good in 12 cases, fair in 5 cases, bad in 1 case. The excellent and good rate was 78.57%(22/28). Conclusion Treatment of humerus extremity comminuted fractures by double plates through olecranon osteotomy followed by early functional exercise are excellent with satisfactory functional recovery.%目的 评价经鹰嘴截骨双钢板内固定治疗肱骨远端粉碎性骨折的疗效.方法 对28例肱骨远端粉碎性骨折采取后路经鹰嘴截骨切口,开放解剖复位,双钢板内固定,术后早期功能锻炼.结果 28例患者获得9~31个月的随访,用改良Cansebaum评分系统评价术后疗效,优10例,良12例,可5例,差1例,优良率78.57%(22/28).结论 经鹰嘴截骨双钢板内固定和早期的功能锻炼,不失为治疗肱骨远端粉碎性骨折的一种有效手段.

  2. [Results after internal fixation of humerus distal fractures in patients over than 65 years old]. (United States)

    Serrano-Mateo, L; Lopiz, Y; León-Serrano, C; García-Fernández, C; López-Durán-Stern, L; Marco, F


    Distal humerus fractures in the elderly frequently associated with poor bone quality and comminution, making it harder to achieve proper osteosynthesis. Our aim is to evaluate the radiological and functional results of open reduction and internal fixation of these fractures. Retrospective study of 26 patients treated by open reduction and internal fixation between the years 2005-2010. Mean follow-up was 42 months. At final follow-up, a radiography evaluation (Knirk and Jupiter score) and clinical examination using Mayo Elbow Performance Score and Quick-Disabilities of the Arm, Shoulder and Hand Score was performed. Mean age of the group was 76.8 years (65-89), with 83% of the patients being female. Sixteen patients suffered type C fractures and 8 type A by AO classification. All underwent posterior surgical approach. Mean elbow flexion reached 118.86°, with a mean extension deficit of 25°. More than 3-quarters (79.1%) of the patients showed 0-1 grade degenerative changes on the X-ray films at final follow-up. Functional results reached an average 19.87 points on Quick-Disabilities of the Arm, Shoulder and Hand Score, and 85 points on Mayo Elbow Performance Score scores. Non-union occurred in 2 cases: distal humerus in one patient and olecranon osteotomy in another. Ulnar nerve neuropraxia was recorded in 2 cases, and radial nerve in one. All 3 recovered uneventfully. Revision surgery was required, with 2 patients needing hardware removal and one a new fixation. Treatment by open reduction and internal fixation with plating in elderly people for type A and C distal humerus fractures gives good functional results regarding this population, and thus scarcely disturbs their quality of life. Copyright © 2012 SECOT. Published by Elsevier Espana. All rights reserved.

  3. Effect of Natural Fractures on Hydraulic Fracturing (United States)

    Ben, Y.; Wang, Y.; Shi, G.


    Hydraulic Fracturing has been used successfully in the oil and gas industry to enhance oil and gas production in the past few decades. Recent years have seen the great development of tight gas, coal bed methane and shale gas. Natural fractures are believed to play an important role in the hydraulic fracturing of such formations. Whether natural fractures can benefit the fracture propagation and enhance final production needs to be studied. Various methods have been used to study the effect of natural fractures on hydraulic fracturing. Discontinuous Deformation Analysis (DDA) is a numerical method which belongs to the family of discrete element methods. In this paper, DDA is coupled with a fluid pipe network model to simulate the pressure response in the formation during hydraulic fracturing. The focus is to study the effect of natural fractures on hydraulic fracturing. In particular, the effect of rock joint properties, joint orientations and rock properties on fracture initiation and propagation will be analyzed. The result shows that DDA is a promising tool to study such complex behavior of rocks. Finally, the advantages of disadvantages of our current model and future research directions will be discussed.

  4. Fracture channel waves (United States)

    Nihei, Kurt T.; Yi, Weidong; Myer, Larry R.; Cook, Neville G. W.; Schoenberg, Michael


    The properties of guided waves which propagate between two parallel fractures are examined. Plane wave analysis is used to obtain a dispersion equation for the velocities of fracture channel waves. Analysis of this equation demonstrates that parallel fractures form an elastic waveguide that supports two symmetric and two antisymmetric dispersive Rayleigh channel waves, each with particle motions and velocities that are sensitive to the normal and tangential stiffnesses of the fractures. These fracture channel waves degenerate to shear waves when the fracture stiffnesses are large, to Rayleigh waves and Rayleigh-Lamb plate waves when the fracture stiffnesses are low, and to fracture interface waves when the fractures are either very closely spaced or widely separated. For intermediate fracture stiffnesses typical of fractured rock masses, fracture channel waves are dispersive and exhibit moderate to strong localization of guided wave energy between the fractures. The existence of these waves is examined using laboratory acoustic measurements on a fractured marble plate. This experiment confirms the distinct particle motion of the fundamental antisymmetric fracture channel wave (A0 mode) and demonstrates the ease with which a fracture channel wave can be generated and detected.

  5. Traumatic thoracolumbar spine fractures

    NARCIS (Netherlands)

    J. Siebenga (Jan)


    textabstractTraumatic spinal fractures have the lowest functional outcomes and the lowest rates of return to work after injury of all major organ systems.1 This thesis will cover traumatic thoracolumbar spine fractures and not osteoporotic spine fractures because of the difference in fracture

  6. Assessment of fracture risk

    Energy Technology Data Exchange (ETDEWEB)

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


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

  7. [Periprosthetic Acetabulum Fractures]. (United States)

    Schreiner, A J; Stuby, F; de Zwart, P M; Ochs, B G


    In contrast to periprosthetic fractures of the femur, periprosthetic fractures of the acetabulum are rare complications - both primary fractures and fractures in revision surgery. This topic is largely under-reported in the literature; there are a few case reports and no long term results. Due to an increase in life expectancy, the level of patients' activity and the number of primary joint replacements, one has to expect a rise in periprosthetic complications in general and periprosthetic acetabular fractures in particular. This kind of fracture can be intra-, peri- or postoperative. Intraoperative fractures are especially associated with insertion of cementless press-fit acetabular components or revision surgery. Postoperative periprosthetic fractures of the acetabulum are usually related to osteolysis, for example, due to polyethylene wear. There are also traumatic fractures and fractures missed intraoperatively that lead to some kind of insufficiency fracture. Periprosthetic fractures of the acetabulum are treated conservatively if the implant is stable and the fracture is not dislocated. If surgery is needed, there are many possible different surgical techniques and challenging approaches. That is why periprosthetic fractures of the acetabulum should be treated by experts in pelvic surgery as well as revision arthroplasty and the features specific to the patient, fracture and prosthetic must always be considered. Georg Thieme Verlag KG Stuttgart · New York.

  8. Imaging of vertebral fractures

    Directory of Open Access Journals (Sweden)

    Ananya Panda


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

  9. Influence of hooks and a lag screw on internal fixation plates for lateral malleolar fracture: a biomechanical and ergonomic study. (United States)

    Sakai, Rina; Uchino, Masataka; Yoneo, Terumasa; Ohtaki, Yasuaki; Minehara, Hiroaki; Matsuura, Terumasa; Gomi, Tsutomu; Ujihira, Masanobu


    For internal fixation of AO classification Type B lateral malleolar fracture, insertion of lag screws into the fracture plane and fixation with a one-third tubular plate as a neutralization plate are the standard treatment procedures. The one-third tubular plate is processed to a hook shape and hung on the distal end of the fibula. In this study, to compare the function of the hook and lag screws of a one-third tubular plate and LCP for osteosynthesis of lateral malleolar fracture, mechanical indices of internal fixation were compared among the one-third tubular plates with lag screws with and without the hook and a locking compression plate. As mechanical tests, a compression test was performed in which compression in the bone axis direction produced by supporting the body weight was simulated, and a torsion test was performed in which external rotation of the bone axis caused by plantar flexion of the ankle joint was simulated. Muscle strength during walking and the force and torque acting on the ankle and knee joints were determined using inverse dynamic analysis. Finite element analysis was performed to analyze the function of hooks and lag screws. The joint reaction force determined by inverse dynamic analysis was adopted as the loading condition of finite element analysis. A stiffness equivalent to that of healthy bone could be achieved by all three internal fixations. It was clarified that the presence of the hook does not make a difference in stiffness. Displacement of the one-third tubular plate was small regardless of the presence or absence of the hook compared with those of locking compression plates. The presence of the hook did not make any difference in stiffness, suggesting that active preparation of the hook is unnecessary. We also clarified that lag screws inhibit displacement.

  10. Fracture Criterion for Fracture Mechanics of Magnets

    Institute of Scientific and Technical Information of China (English)

    潘灏; 杨文涛


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

  11. Associated injuries in traumatic sternal fractures: a review of the National Trauma Data Bank. (United States)

    Oyetunji, Tolulope A; Jackson, Hope T; Obirieze, Augustine C; Moore, Danier; Branche, Marc J; Greene, Wendy R; Cornwell, Edward E; Siram, Suryanarayana M


    Sternal fractures occur infrequently with blunt force trauma. The demographics and epidemiology of associated injuries have not been well characterized from a national trauma database. The National Trauma Data Bank was queried for patients with closed sternal fractures. The demographics were analyzed by age, gender, mechanism and indicators of anatomic and physiologic injuries. Types of commonly associated injuries were also determined. A total of 23,985 records were analyzed. Males accounted for 68.3 per cent and whites 70.9 per cent. Motor vehicle crash was the leading mechanism. More than 56 per cent had severe injuries based on Injury Severity Score (greater than 15) and 17 per cent with Glasgow Coma Score 8 or less. Crude mortality was 7.9 per cent. The majority (57.8%) and approximately one-third (33.7%) of the patients had rib fractures and lung contusions, respectively, 22.0 per cent with closed pneumothorax, 21.6 per cent had a closed thoracic vertebra fracture, 16.9 per cent with lumbar spine fracture, 3.9 per cent with concussion, and blunt cardiac injury in 3.6 per cent. Sternal fractures are usually associated with severe blunt trauma. Lung contusion remains the leading associated injury followed by vertebral spine fractures. Cardiac injuries are less frequent and vascular injuries less so. Mechanism of injury and presence of sternal fractures should alert providers to these potential associated injuries.

  12. Burnei's "double X" internal fixation technique for supracondylar humerus fractures in children: indications, technique, advantages and alternative interventions : Study and Research Group in Pediatric Orthopaedics-2012. (United States)

    Georgescu, I; Gavriliu, S; Pârvan, A; Martiniuc, A; Japie, E; Ghiță, R; Drăghici, I; Hamei, Ş; Ţiripa, I; El Nayef, T; Dan, D


    fractures, in supracondylar fractures with vascular injury, in late presenting fractures, in case of loss of reduction under cast immobilization or in case of surgery with other types of fixation that is deteriorated. We have been using Burnei's osteosynthesis for about 10 years. This paper aims to present the operative technique, its results and advantages. 56 cases were treated with Burnei's "double X" osteosynthesis in "Alexandru Pesamosca" Surgery Clinics, from 2001 to 2011. We used the Kocher approach and the aim of surgery was to obtain a fixation that does not require cast immobilization and that allows motion 24 hours after the surgery. The wires placed in "double X" must not occupy the olecranon fossa. The reduction must be anatomical and the olecranon fossa free. Flexion and extension of the elbow must be in normal range after surgery without crackles or limitations. This surgery was performed on patients with: Loss of reduction after 10 days with cast immobilization; Surgery with other types of fixation, deteriorated; Polytraumatized patients with supracondylar fracture; After neglected or late presenting fractures, without the orthopedic reduction made in emergency; Fractures with edema and blistering. The patients' ages ranged 3 to12 years old, the mean age for girls was 7,3 years and 6,8 for boys. The hospitalization ranged 3 to 7 days, the average period being of 5 days. The wires had been pulled out after 21 days. The total recovery of the flexion and extension motion of the elbow was, depending on the age, between 21 and 40 days with an average period of 30 days. There were 5 cases of minor complications: in 3 cases the wires migrated outwards up to the 10th day and in 2 cases the wires were found in the olecranon fossa. The CT exam highlighted the impingement effect and the wire that passed through the olecranon fossa had to be removed between the 7th and the 9th day. No reported cases of cubitus varus or valgus were reported. The Burnei's "double X

  13. Burnei’s “double X" internal fixation technique for supracondylar humerus fractures in children: indications, technique, advantages and alternative interventions (United States)

    Georgescu, I; Gavriliu, S; Pârvan, A; Martiniuc, A; Japie, E; Ghiță, R; Drăghici, I; Hamei, S; Ţiripa, I; El Nayef, T; Dan, D


    patients with supracondylar fractures, in supracondylar fractures with vascular injury, in late presenting fractures, in case of loss of reduction under cast immobilization or in case of surgery with other types of fixation that is deteriorated. We have been using Burnei’s osteosynthesis for about 10 years. Aim. This paper aims to present the operative technique, its results and advantages. Materials and methods. 56 cases were treated with Burnei’s "double X" osteosynthesis in "Alexandru Pesamosca" Surgery Clinics, from 2001 to 2011. We used the Kocher approach and the aim of surgery was to obtain a fixation that does not require cast immobilization and that allows motion 24 hours after the surgery. The wires placed in "double X" must not occupy the olecranon fossa. The reduction must be anatomical and the olecranon fossa free. Flexion and extension of the elbow must be in normal range after surgery without crackles or limitations. This surgery was performed on patients with: • Loss of reduction after 10 days with cast immobilization; • Surgery with other types of fixation, deteriorated; • Polytraumatized patients with supracondylar fracture; • After neglected or late presenting fractures, without the orthopedic reduction made in emergency; • Fractures with edema and blistering. Results and complications. The patients’ ages ranged 3 to12 years old, the mean age for girls was 7,3 years and 6,8 for boys. The hospitalization ranged 3 to 7 days, the average period being of 5 days. The wires had been pulled out after 21 days. The total recovery of the flexion and extension motion of the elbow was, depending on the age, between 21 and 40 days with an average period of 30 days. There were 5 cases of minor complications: in 3 cases the wires migrated outwards up to the 10th day and in 2 cases the wires were found in the olecranon fossa. The CT exam highlighted the impingement effect and the wire that passed through the olecranon fossa had to be removed between the

  14. Tibia (Shinbone) Shaft Fractures (United States)

    ... energy collisions, such as an automobile or motorcycle crash, are common causes of tibial sha fractures. In cases like these, the bone can be broken into several pieces (comminuted fracture). Sports injuries, such as a fall while skiing or running ...

  15. Fractures in anisotropic media (United States)

    Shao, Siyi

    Rocks may be composed of layers and contain fracture sets that cause the hydraulic, mechanical and seismic properties of a rock to be anisotropic. Coexisting fractures and layers in rock give rise to competing mechanisms of anisotropy. For example: (1) at low fracture stiffness, apparent shear-wave anisotropy induced by matrix layering can be masked or enhanced by the presence of a fracture, depending on the fracture orientation with respect to layering, and (2) compressional-wave guided modes generated by parallel fractures can also mask the presence of matrix layerings for particular fracture orientations and fracture specific stiffness. This report focuses on two anisotropic sources that are widely encountered in rock engineering: fractures (mechanical discontinuity) and matrix layering (impedance discontinuity), by investigating: (1) matrix property characterization, i.e., to determine elastic constants in anisotropic solids, (2) interface wave behavior in single-fractured anisotropic media, (3) compressional wave guided modes in parallel-fractured anisotropic media (single fracture orientation) and (4) the elastic response of orthogonal fracture networks. Elastic constants of a medium are required to understand and quantify wave propagation in anisotropic media but are affected by fractures and matrix properties. Experimental observations and analytical analysis demonstrate that behaviors of both fracture interface waves and compressional-wave guided modes for fractures in anisotropic media, are affected by fracture specific stiffness (controlled by external stresses), signal frequency and relative orientation between layerings in the matrix and fractures. A fractured layered medium exhibits: (1) fracture-dominated anisotropy when the fractures are weakly coupled; (2) isotropic behavior when fractures delay waves that are usually fast in a layered medium; and (3) matrix-dominated anisotropy when the fractures are closed and no longer delay the signal. The

  16. Sprains, Strains and Fractures (United States)

    ... Young Physicians Annual Scientific Meeting Webinars Careers in Podiatry APMA 2040 Student Profiles CPME REdRC Manage Your ... and fractures. Many fractures and sprains occur during sports. Football players are particularly vulnerable to foot and ...

  17. Hip fracture - discharge (United States)

    ... this page: // Hip fracture - discharge To use the sharing features on this page, please enable JavaScript. Hip fracture surgery is done to repair a break in ...

  18. Hip fracture surgery (United States)

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

  19. Metatarsal stress fractures - aftercare (United States)

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

  20. Periprosthetic acetabular fractures. (United States)

    Benazzo, Francesco; Formagnana, Mario; Bargagliotti, Marco; Perticarini, Loris


    The aim of this article is to propose a diagnostic and therapeutic algorithm for the acetabular periprosthetic fractures. This article explores the current literature on the epidemiology, causes and classification of periprosthetic acetabular fractures. Integrating data with the experience of the authors, it offers a guide to diagnosis and possible therapeutic strategies. Intra-operative fractures can occur during rasping, reaming or implant impaction, and they must be treated immediately if the component(s) is (are) unstable. Post-operative fractures can be due to major trauma (acute fractures) or minor forces in bone osteolysis; it is possible to plan reconstruction and fixation according to fracture characteristics. Treatment choice depends upon fracture site and implant stability. Periprosthetic acetabular fractures are uncommon complications that can occur intra-operatively or post-operatively, and a reconstructive surgeon must be able to manage the procedure. Accurate planning and reconstruction implant are necessary to achieve good cup stability.

  1. Identifying osteoporotic vertebral fracture


    Griffith, James F.


    Osteoporosis per se is not a harmful disease. It is the sequela of osteoporosis and most particularly the occurrence of osteoporotic fracture that makes osteoporosis a serious medical condition. All of the preventative measures, investigations, treatment and research into osteoporosis have one primary goal and that is to prevent the occurrence of osteoporotic fracture. Vertebral fracture is by far and away the most prevalent osteoporotic fracture. The significance and diagnosis of vertebral f...

  2. Treatment of pediatric femoral shaft fractures by stainless steel and titanium elastic nail system: A randomized comparative trial

    Directory of Open Access Journals (Sweden)

    Tank Gyaneshwar


    Conclusion: Majority of paediatric femoral shaft fractures are now treated operatively by elastic stable intramedullary nails. Operative intervention results in a shorter hospital stay and has economic and social benefits over conservative treatment. The cost of stainless steel nail is one third the cost of titanium nail. However, the clinico-radiological results are not significantly different between titanium and stainless steel nails at one year follow-up as observed by our study.

  3. Fracture prevention in men

    NARCIS (Netherlands)

    Geusens, PP; Sambrook, P.N.; Lems, W.F.


    The lifetime risk of experiencing a fracture in 50-year-old men is lower (20%) than the risk in women (50%). Consequently, much less research has been carried out on osteoporosis and fracture risk in men. Differences in the risk and incidence of fractures between men and women are related to differe

  4. Imaging of insufficiency fractures

    Energy Technology Data Exchange (ETDEWEB)

    Krestan, Christian [Department of Radiology, Medical University of Vienna, Vienna General Hospital, Waehringerstr. 18-20, 1090 Vienna (Austria)], E-mail:; Hojreh, Azadeh [Department of Radiology, Medical University of Vienna, Vienna General Hospital, Waehringerstr. 18-20, 1090 Vienna (Austria)


    This review focuses on the occurrence, imaging and differential diagnosis of insufficiency fractures. Prevalence, the most common sites of insufficiency fractures and their clinical implications are discussed. Insufficiency fractures occur with normal stress exerted on weakened bone. Postmenopausal osteoporosis is the most common cause of insufficiency fractures. Other conditions which affect bone turnover include osteomalacia, hyperparathyroidism, chronic renal failure and high-dose glucocorticoid therapy. It is a challenge for the radiologist to detect and diagnose insufficiency fractures, and to differentiate them from other bone lesions. Radiographs are still the most widely used imaging method for identification of insufficiency fractures, but sensitivity is limited, depending on the location of the fractures. Magnetic resonance imaging (MRI) is a very sensitive tool to visualize bone marrow abnormalities associated with insufficiency fractures. Thin section, multi-detector computed tomography (MDCT) depicts subtle fracture lines allowing direct visualization of cortical and trabecular bone. Bone scintigraphy still plays a role in detecting fractures, with good sensitivity but limited specificity. The most important differential diagnosis is underlying malignant disease leading to pathologic fractures. Bone densitometry and clinical history may also be helpful in confirming the diagnosis of insufficiency fractures.

  5. [Operative treatment of Dubberley type 3B capitulum-trochlea fractures]. (United States)

    Hu, Xiaochuan; Xiang, Ming; Yang, Guoyong; Chen, Hang; Tang, Haochen


    To investigate the method and effectiveness of operative treatment of Dubberley type 3B capitulum-trochlea fractures. Between January 2009 and December 2012, 8 cases of Dubberley type 3B capitulum- trochlea fractures were treated. There were 2 males and 6 females with an average age of 55 years (range, 43-65 years). The injury was caused by falling in 6 cases, electric bicycle accident in 1 case, and traffic accident in 1 case. All fractures were fresh and closed injury. No neural or vascular injury was found. The time between injury and operation was 3-15 days (mean, 5.9 days). Olecranon osteotomy was performed by a posterior midline skin incision of the elbow; 3.0 mm Herbert compression screws placed from posterior to anterior, 2.4 mm L shape locking compression plate designed for distal radius or 2.7 mm anatomical locking compression plate designed for distal humerus and 1.0 mm Kirschner wires or 3.0 mm Herbert screw for the transverse and coronal plane in the subchondral of anterior articular surface were used for fixation; and the lateral and medial collateral ligaments were repaired. All incisions healed by first intention. The patients were followed up 12-18 months (mean, 14.5 months). The X-ray films showed that fracture healing was achieved at 12-24 weeks (mean, 15 weeks) in 7 cases. Fracture nonunion and partial bone resorption in the capitellum were observed in 1 case. No failure of internal fixation, ulnohumeral joint instability, or traumatic arthritis occurred. At last follow-up, the range of motion of injured elbow was 0-40° in extension (mean 25.0°), 100-135° in flexion (mean, 116.3°), 60-70° in pronation (mean, 61.3°), and 80-90° in supination (mean, 81.3°). The elbow function score was 64-96 (mean, 81.1) according to the Broberg-Morrey evaluation criteria; the results were excellent in 2 cases, good in 4 cases, and fair in 2 cases with an excellent and good rate of 75%. The visual analogue scale (VAS) score was 0-3 (mean, 1). For Dubbelley

  6. Proximal humerus fractures. (United States)

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


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

  7. Stress fractures in runners. (United States)

    McCormick, Frank; Nwachukwu, Benedict U; Provencher, Matthew T


    Stress fractures are a relatively common entity in athletes, in particular, runners. Physicians and health care providers should maintain a high index of suspicion for stress fractures in runners presenting with insidious onset of focal bone tenderness associated with recent changes in training intensity or regimen. It is particularly important to recognize “high-risk” fractures, as these are associated with an increased risk of complication. A patient with confirmed radiographic evidence of a high-risk stress fracture should be evaluated by an orthopedic surgeon. Runners may benefit from orthotics, cushioned sneakers, interval training, and vitamin/calcium supplementation as a means of stress fracture prevention.

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

    Energy Technology Data Exchange (ETDEWEB)

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


    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.

  9. Fractures in multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Jensen, K


    In a cross-sectional study of 299 MS patients 22 have had fractures and of these 17 after onset of MS. The fractures most frequently involved the femoral neck and trochanter (41%). Three patients had had more than one fracture. Only 1 patient had osteoporosis. The percentage of fractures increased...... with increasing age and disease duration. Among 34 deceased MS patients 4 had had fractures. These findings are discussed in relation to physical and cognitive impairment in MS. A case-control study is recommended....

  10. [Fractures of carpal bones]. (United States)

    Lögters, T; Windolf, J


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

  11. Orbital fractures: a review

    Directory of Open Access Journals (Sweden)

    Jeffrey M Joseph


    Full Text Available Jeffrey M Joseph, Ioannis P GlavasDivision of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology, School of Medicine, New York University, New York, NY, USA; Manhattan Eye, Ear, and Throat Hospital, New York, NY, USAAbstract: This review of orbital fractures has three goals: 1 to understand the clinically relevant orbital anatomy with regard to periorbital trauma and orbital fractures, 2 to explain how to assess and examine a patient after periorbital trauma, and 3 to understand the medical and surgical management of orbital fractures. The article aims to summarize the evaluation and management of commonly encountered orbital fractures from the ophthalmologic perspective and to provide an overview for all practicing ophthalmologists and ophthalmologists in training.Keywords: orbit, trauma, fracture, orbital floor, medial wall, zygomatic, zygomatic complex, zmc fracture, zygomaticomaxillary complex fractures 

  12. Oblique Axis Body Fracture

    DEFF Research Database (Denmark)

    Takai, Hirokazu; Konstantinidis, Lukas; Schmal, Hagen


    Purpose. Anderson type III odontoid fractures have traditionally been considered stable and treated conservatively. However, unstable cases with unfavorable results following conservative treatment have been reported. Methods. We present the cases of two patients who sustained minimally displaced...... Anderson type III fractures with a characteristic fracture pattern that we refer to as "oblique type axis body fracture." Results. The female patients aged 90 and 72 years, respectively, were both diagnosed with minimally displaced Anderson type III fractures. Both fractures had a characteristic "oblique...... type" fracture pattern. The first patient was treated conservatively with cervical spine immobilization in a semirigid collar. However, gross displacement was noted at the 6-week follow-up visit. The second patient was therefore treated operatively by C1-C3/4 posterior fusion and the course...

  13. Effect of storage environment on the bond strength of reattachment of crown fragments to fractured teeth

    Directory of Open Access Journals (Sweden)

    Farzaneh Shirani


    Full Text Available Aim: The aim of this study was to examine various storage environments for storing fragments before being bonded to the remaining teeth and also estimate the required force to fracture the restored teeth. Materials and Methods: Sixty mandibular incisor teeth were fractured on the incisal one-third and were divided into five groups of 12 each to be stored in normal saline, water, milk, saliva and dry environments for 24 hours. All the fractured parts in each group were bonded to their relevant apical parts by an etch and rinse bonding system and a flowable composite resin. The fracture resistance was measured by a universal testing machine, and the results were analyzed using one-way ANOVA and Tukey statistical tests. Results: The results revealed that the difference among the five groups was statistically significant (P<0.001. Tukey tests showed that the force required for fracturing fragments kept in the milk and saliva environments were significantly higher than those for the normal saline, water and dry environments (P<0.05 . Conclusions: It was concluded that keeping the fractured parts in milk and saliva environments can increase the required force for fracturing teeth more than the other environments.

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

    Directory of Open Access Journals (Sweden)

    Al. Șerban


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

  15. Comparison of Pavlik harness application and immediate spica casting for femur fractures in infants. (United States)

    Podeszwa, David A; Mooney, James F; Cramer, Kathryn E; Mendelow, Michael J


    This retrospective study compares Pavlik harness application versus spica casting for the treatment of children under 1 year of age with a femoral shaft fracture. The clinical and radiographic outcomes of 24 patients treated in a Pavlik harness were compared with 16 patients treated in a spica cast. The average age and weight of the two groups were significantly different, but there were no differences in radiographic outcomes between the Pavlik and spica cast groups. Approximately one third of all spica patients had a skin complication that added an additional risk to the patient. There were no similar complications in the Pavlik group. There were no differences in the outcome of the fractures in the two groups. The authors believe that all children under 1 year of age with a femoral shaft fracture are candidates for treatment with a Pavlik harness.

  16. [Fracture endoprosthesis of distal humerus fractures]. (United States)

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


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


    Institute of Scientific and Technical Information of China (English)

    刘宝荣; 康亦锋


    Objective:To evaluate the effect of encircled fixer of shape memory alloy on bone fracture. Methods:A total of twenty patients with eighteen males and two females was studied. There were three patients with fractares in the upper one third of thighbone, five with fractures in the middle part of thighbone, six with humeral fractures, three with collarbone fractures,one with ulna fracture and two with thighbone fractures as complication of artificial hipbone arthroplasty. After exposure and fixation of fracture ends, prepared encircled fixer was inserted into 0~4℃ normal reline(NS) to lower its temperature, then pulled out with a clamp. Encircled fixer was put on the tersile side of the fractured bone(center pointed to fracture line), restored and stabilized after raising temperature in 40℃ NS. Results: Encircled fixers of shape memory alloy were used to treat twenty patients with bone fracture.Clinical concrescence was obtained in 1.5 to 3 months after operation,and the joint gained its normal function without complication. Conclusion:Encircled fixer of shape memory alloy has features as exerting vertical pressure continoulsy, little stress shield effect and convenient manipulation, especially adapt to stem fracture after artificial arthroplasty.

  18. Only about One-Third of Americans Use Condoms: CDC (United States)

    ... Programs-PCAP Services at Northwell Health in New Hyde Park, N.Y. But condoms do have a ... Women's Health Programs-PCAP Services, Northwell Health, New Hyde Park, N.Y.; Aug. 10, 2017, report, Condom ...

  19. Growing skull fracture

    Directory of Open Access Journals (Sweden)

    Mihajlović Miljan H.


    Full Text Available Background. Growing skull fracture or craniocerebral erosion is a rare complication of linear skull fracture in childhood. It is characterized by progressive diastatic enlargement of the fracture line, which leads to a cranial defect, dural cleft, and cerebral herniation. It is presented as a soft pulsabile scalp swelling above the fracture, with a clear cranial defect. Case report. In this paper we presented a patient, an 8-month-old boy with the growing skull fracture revealed four weeks after the injury. After the surgical treatment, the boy was in a good general condition without the presence of neurologic impairment. Conclusion. Early recognition of craniocerebral erosion is very important. Timely detection prevents further progression of the disease and the evolution of neurological impairment. Surgery is the method of choice for treating a growing skull fracture .

  20. Pelvic fractures and mortality.


    K.H. Chong; DeCoster, T.; Osler, T.; Robinson, B.


    A retrospective study of all patients (N = 343) with pelvic fractures admitted to our trauma service was conducted to evaluate the impact of pelvic fractures on mortality. All patients sustained additional injuries with an average Injury Severity Score (ISS) of twenty. Thirty-six patients died. This group had more severe pelvic fractures as graded by the Tile classification as well as a greater number and severity of associated injuries. Six patients died as a direct result of pelvic hemorrha...

  1. Oblique Axis Body Fracture

    DEFF Research Database (Denmark)

    Takai, Hirokazu; Konstantinidis, Lukas; Schmal, Hagen;


    was uneventful. Conclusions. Oblique type axis body fractures resemble a highly unstable subtype of Anderson type III fractures with the potential of severe secondary deformity following conservative treatment, irrespective of initial grade of displacement. The authors therefore warrant a high index of suspicion......Purpose. Anderson type III odontoid fractures have traditionally been considered stable and treated conservatively. However, unstable cases with unfavorable results following conservative treatment have been reported. Methods. We present the cases of two patients who sustained minimally displaced...

  2. [(Impending) pathological fracture]. (United States)

    Sutter, P M; Regazzoni, P


    Pathological fractures will be encountered in increasing frequency due to more patients with cancer, surviving a longer period. The skeleton is the third most frequent localization for metastases. Breast cancer is still the most common primary tumor, but bone metastases from lung cancer seem to be diagnosed more and more. Despite of finding metastases most often in the spinal column, fractures are seen mostly at the femoral site. A pathological fracture and, in almost all cases, an impending fracture are absolute indication for operation. An exact definition of an "impending fracture" is still lacking; it is widely accepted, that 50 per cent of bone mass must be destroyed before visualization in X-ray is possible, thus defining an impending fracture. The score system by Mirels estimates the fracture risk by means of four parameters (localization, per cent of destructed bone mass, type of metastasis, pain). Improving quality of life, relieving pain, preferably with a single operation and a short length of stay are the goals of (operative) treatment. For fractures of the proximal femur, prosthetic replacement, for fractures of the subtrochanteric region or the shaft, intramedullary nails are recommended. Postoperative radiation therapy possibly avoids tumor progression. In patient with a good long term prognosis, tumor should be removed locally aggressive.

  3. Fracture mechanics safety approaches

    Energy Technology Data Exchange (ETDEWEB)

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


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

  4. Scaphoid fractures in children

    Directory of Open Access Journals (Sweden)

    Gajdobranski Đorđe


    Full Text Available Introduction. Scaphoid fractures are rare in childhood. Diagnosis is very difficult to establish because carpal bones are not fully ossified. In suspected cases comparative or delayed radiography is used, as well as computerized tomography, magnetic resonance imaging, ultrasound and bone scintigraphy. Majority of scaphoid fractures are treated conservatively with good results. In case of delayed fracture healing various types of treatment are available. Objective. To determine the mechanism of injury, clinical healing process, types and outcome of treatment of scaphoid fractures in children. Methods. We retrospectively analyzed patients with traumatic closed fracture of the scaphoid bone over a ten-year period (2002-2011. The outcome of the treatment of “acute” scaphoid fracture was evaluated using the Mayo Wrist Score. Results. There were in total 34 patients, of mean age 13.8 years, with traumatic closed fracture of the scaphoid bone, whose bone growth was not finished yet. Most common injury mechanism was fall on outstretched arm - 76% of patients. During the examined period 31 children with “acute” fracture underwent conservative treatment, with average immobilization period of 51 days. Six patients were lost to follow-up. In the remaining 25 patients, after completed rehabilitation, functional results determined by the Mayo Wrist Score were excellent. Conclusion. Conservative therapy of “acute” scaphoid fractures is an acceptable treatment option for pediatric patients with excellent functional results.

  5. Atraumatic First Rib Fracture

    Directory of Open Access Journals (Sweden)

    Koray Aydogdu


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

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

    Directory of Open Access Journals (Sweden)

    K N Dubey


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

  7. Hip Fractures among Older Adults (United States)

    ... online training for health care providers. Learn More Hip Fractures Among Older Adults Recommend on Facebook Tweet Share ... get older. What You Can Do to Prevent Hip Fractures You can prevent hip fractures by taking steps ...

  8. Pneumothorax complicating isolated clavicle fracture. (United States)

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


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

  9. The Comprehensive AOCMF Classification System: Condylar Process Fractures - Level 3 Tutorial. (United States)

    Neff, Andreas; Cornelius, Carl-Peter; Rasse, Michael; Torre, Daniel Dalla; Audigé, Laurent


    This tutorial outlines the detailed system for fractures of the condylar process at the precision level 3 and is organized in a sequence of sections dealing with the description of the classification system within topographical subdivisions along with rules for fracture coding and a series of case examples with clinical imaging. Basically, the condylar process comprises three fracture levels and is subdivided into the head region, the condylar neck, and the condylar base. Fractures of the condylar head show typical fracture lines either within the lateral pole zone, which may lead to loss of vertical height, or medially to the pole zone, with the latter ones usually not compromising the vertical condyle to fossa relation. In condylar head fractures, the morphology is further described by the presence of minor or major fragmentation, the vertical apposition of fragments at the plane of the head fracture, the displacement of the condylar head with regard to the fossa including a potential distortion of the condylar head congruency resulting in dystopic condyle to fossa relations and the presence or absence of a loss of vertical ramus height. A specific vertical fracture pattern extending from the head to the neck or base subregion is considered. Fractures of the condylar neck and base can be differentiated according to a newly introduced one-third to two-thirds rule with regard to the proportion of the fracture line above and below the level of the sigmoid notch, which is presented in the classification article, and are basically subdivided according to the presence or absence of displacement or dislocation. In both condylar neck and base fractures, the classification is again based on the above mentioned parameters such as fragmentation, displacement of the condylar head with regard to the fossa, including dystopic condyle to fossa relations and loss of vertical ramus height, that is, according to the measurement of the condylar process. In addition, the

  10. A new technique of fixation of radial head fractures using a modified tubular plate

    Directory of Open Access Journals (Sweden)

    Guha A


    Full Text Available Radial head fractures are fairly common, occurring in 17-44% of all elbow injuries. Mason Type 2 fractures may be fixed using mini fragment screws, this fixation often needing augmentation with a plate to make the construct rotationally stable. However, the drill holes needed to fix the plate to the radial head, carry the risk of inflicting more injury to the fractured fragments. In our case, the radial head fracture was fixed with a modified one-third tubular plate. The plate was cut through the distal hole and the two cut ends were bent into hooks. These two hooks were engaged into two breaches made on the margin of the radial head and this provided rotational stability to the head without causing further damage. The fracture healed well and the patient regained full movement in the elbow. We conclude that this method may be used to fix fractures of the radial head, which require additional support with a plate.

  11. Investigation of the fracture mechanics of boride composites (United States)

    Kaufman, L.; Clougherty, E. V.; Nesor, H.


    Fracture energies of WC-6Co, Boride 5 (ZrB2+SiC), Boride 8(ZrB2+SiC+C) and Boride 8-M2(ZrB2+SiC+C) were measured by slow bend and impact tests of notched charpy bars. Cobalt bonded tungsten carbide exhibited impact energies of 0.76 ft-lb or 73.9 in-lb/square inch. Boride 5 and the Boride 8 exhibit impact energies one third and one quarter of that observed for WC-6Co comparing favorably with measurements for SiC and Si3N4. Slow bend-notched bar-fracture energies for WC-6Co were near 2.6 in-lb/square inch or 1/20 the impact energies. Slow bend energies for Boride 8-M2, Boride 8 and Boride 5 were 58%, 42% and 25% of the value observed for WC-6Co. Fractograph showed differences for WC-6Co where slow bend testing resulted in smooth transgranular cleavage while samples broken by impact exhibited intergranular failures. By contrast the boride fractures showed no distinction based on testing method. Fabrication studies were conducted to effect alteration of the boride composites by alloying and introduction of graphite cloth.

  12. Vertebral Fracture Prediction

    DEFF Research Database (Denmark)


    Vertebral Fracture Prediction A method of processing data derived from an image of at least part of a spine is provided for estimating the risk of a future fracture in vertebraeof the spine. Position data relating to at least four neighbouring vertebrae of the spine is processed. The curvature...

  13. Radial head fracture - aftercare (United States)

    ... Philadelphia, PA: Elsevier Saunders; 2015:chap 6. Prawer A. Radius and ulna fractures. In: Eiff M, Hatch R, eds. Fracture Management for Primary Care . 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap ... PhD, and the A.D.A.M. Editorial team. Related MedlinePlus Health ...

  14. Displaced patella fractures. (United States)

    Della Rocca, Gregory J


    Displaced patella fractures often result in disruption of the extensor mechanism of the knee. An intact extensor mechanism is a requirement for unassisted gait. Therefore, operative treatment of the displaced patella fracture is generally recommended. The evaluation of the patella fracture patient includes examination of extensor mechanism integrity. Operative management of patella fractures normally includes open reduction with internal fixation, although partial patellectomy is occasionally performed, with advancement of quadriceps tendon or patellar ligament to the fracture bed. Open reduction with internal fixation has historically been performed utilizing anterior tension band wiring, although comminution of the fracture occasionally makes this fixation construct inadequate. Supplementation or replacement of the tension band wire construct with interfragmentary screws, cerclage wire or suture, and/or plate-and-screw constructs may add to the stability of the fixation construct. Arthrosis of the patellofemoral joint is very common after healing of patella fractures, and substantial functional deficits may persist long after fracture healing has occurred. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.


    Institute of Scientific and Technical Information of China (English)



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

  16. Transphyseal Distal Humerus Fracture. (United States)

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


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

  17. Galeazzi fracture-dislocations. (United States)

    Mikić, Z D


    Among 125 patients with the Galeazzi-type fracture-dislocation of the forearm, there were fourteen children and eighty-six adults with the classic Galeazzi lesion, and twenty-five patients with a special type -- fracture of both bones and dislocation of the distal radio-ulnar joint. Conservative management was successful only in children. In adults this method resulted in failure in 80 per cent of cases. The results of operative treatment were much better. The fracture fragments of the radius and the dislocation of the radio-ulnar joint in this complex injury are very unstable, especially in the lesion with fractures of the radius and ulna, and it appears that rigid internal fixation is necessary for the dislocation as well as the fracture. With combined fixation over half of the results were excellent.

  18. Dynamic fracture mechanics (United States)

    Kobayashi, A. S.; Ramulu, M.


    Dynamic fracture and crack propagation concepts for ductile materials are reviewed. The equations for calculating dynamic stress integrity and the dynamic energy release rate in order to study dynamic crack propagation are provided. The stress intensity factor versus crack velocity relation is investigated. The uses of optical experimental techniques and finite element methods for fracture analyses are described. The fracture criteria for a rapidly propagating crack under mixed mode conditions are discussed; crack extension and fracture criteria under combined tension and shear loading are based on maximum circumferential stress or energy criteria such as strain energy density. The development and use of a Dugdale model and finite element models to represent crack and fracture dynamics are examined.

  19. Tibial Plateau Fractures

    DEFF Research Database (Denmark)

    Elsøe, Rasmus

    This PhD thesis reported an incidence of tibial plateau fractures of 10.3/100,000/year in a complete Danish regional population. The results reported that patients treated for a lateral tibial plateau fracture with bone tamp reduction and percutaneous screw fixation achieved a satisfactory level...... with only the subgroup Sport significantly below the age matched reference population. The thesis reports a level of health related quality of life (Eq5d) and disability (KOOS) significantly below established reference populations for patients with bicondylar tibial plateau fracture treated with a ring...... fixator, both during treatment and at 19 months following injury. In general, the thesis demonstrates that the treatment of tibial plateau fractures are challenging and that some disabilities following these fractures must be expected. Moreover, the need for further research in the area, both with regard...

  20. Dating fractures in infants

    Energy Technology Data Exchange (ETDEWEB)

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


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

  1. 关节镜清理成形术治疗肘骨关节炎伴肘后撞击症%Efficacies of arthroscopic debridement and olecranon fossa plasty in the treatment of osteoarthtis and posterior elbow impingement

    Institute of Scientific and Technical Information of China (English)

    刘玉杰; 王俊良; 李海峰; 齐玮; 王宁


    Objective To evaluate the efficacies of arthroscopic debridement and removal of osteophyma for olecroanon and olecranon fossa plasty for posterior impingement of elbow joint.Methods Between 1999 and 2008,a total of 21 cases were diagnosed with osteoarthritis and posterior elbow impingement.There were 15 males and 6 females.And there were 16 right and 15 left cases.They included volleyball players (n =7),tennis players ( n =7 ),golf enthusiasts ( n =4) and fencers ( n =3 ).The average duration of onset-operation was 3.5 years ( range:2.5 - 8 ).Arthroscopic exploration revealed synovial hyperplasia hypertrophy,cartilage degeneration and olecranon fossa hyperplasia with deformed olecranon fossa.Debridement and plasty were performed.Loose bodies were removed from elbow joint in 6 patients.Partial resection of posterior olecranon tip was performed and osteophytes or fibrous tissue removed in this area.Dynamic observation showed no posterior elbow impingement.Results Postoperative follow-up was conducted in 19 cases and 2 cases became lost to follow-up.The average follow-up period was 25.3 months (range:18 -42).All patients were evaluated preoperatively and postoperatively with the Hospital for Special Surgery Elbow Assessment Scale.The outcomes were excellent ( n =12 ),good ( n =7 ) and fair ( n =2).Postoperative patients elbow swelling and pain relieve,sports and life function returns to normal,elbow flexion and rotating mobility obviously improved.With the elbow radiological films to measure the range of motion,the average range of motion was 90.5° preoperatively and improved to 130° postoperatively.There was significant improvement in all cases.Conclusion Posterior elbow impingement is caused by hyperextension trauma and elbow overuse during specific sporting activities.Arthroscopic debridement and olecroanon or olecranon fossa plasty demonstrates excellent results for posterior impingement of elbow joint.%目的 探讨肘关节镜清理成形术治疗尺骨

  2. Computed tomograms of blowout fracture

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Haruhide; Hayashi, Minoru; Shoin, Katsuo; Hwang, Wen-Zern; Yamamoto, Shinjiro; Yonemura, Taizo


    We studied 18 cases of orbital fractures, excluding optic canal fracture. There were 11 cases of pure blowout fracture and 3 of the impure type. The other 4 cases were orbital fractures without blowout fracture. The cardinal syndromes were diplopia, enophthalmos, and sensory disturbances of the trigeminal nerve in the pure type of blowout fracture. Many cases of the impure type of blowout fracture or of orbital fracture showed black eyes or a swelling of the eyelids which masked enophthalmos. Axial and coronal CT scans demonstrated: 1) the orbital fracture, 2) the degree of enophthalmos, 3) intraorbital soft tissue, such as incarcerated or prolapsed ocular muscles, 4) intraorbital hemorrhage, 5) the anatomical relation of the orbital fracture to the lacrimal canal, the trochlea, and the trigeminal nerve, and 6) the lesions of the paranasal sinus and the intracranial cavity. CT scans play an important role in determining what surgical procedures might best be employed. Pure blowout fractures were classified by CT scans into these four types: 1) incarcerating linear fracture, 2) trapdoor fracture, 3) punched-out fracture, and 4) broad fracture. Cases with severe head injury should be examined to see whether or not blowout fracture is present. If the patients are to hope to return to society, a blowout fracture should be treated as soon as possible. (author).

  3. The epidemiology, morbidity and outcome of fractures in rugby union from a standard population. (United States)

    Robertson, Greg A J; Wood, Alexander M; Heil, Kieran; Aitken, Stuart A; Court-Brown, Charles M


    Rugby union is the second commonest cause of sporting fracture in the UK, yet little is known about patient outcomes following such fractures. To describe the epidemiology of fractures in rugby union, their morbidity and the likelihood of return to rugby post-injury in a known UK population at all skill levels. All rugby union fractures sustained during 2007-2008 in the Edinburgh, Mid and East Lothian populations were prospectively recorded, when patients attended the only adult orthopaedic service in Lothian. The diagnosis was confirmed by an orthopaedic surgeon. Patients living outside the region were excluded from the study. Patients were contacted by telephone in February 2012 to ascertain their progress in return to rugby. A total of 145 fractures were recorded over the study period in 143 patients. The annual incidence of rugby-related fractures was 0.28/1000 of the general population and 29.86/1000 of the adult registered rugby playing population. 120 fractures were of the upper limb and 25 were of the lower limb. 117 fractures (81%) in 115 patients (80%) were followed up at a mean interval of 50 months (range 44-56 months). 87% of the cohort returned to rugby post-injury (87% of upper limb fractures and 86% of lower limb fractures), with 85% returning to rugby at the same level or higher. Of those who returned, 39% did so by 1 month post-injury, 77% by 3 months post-injury and 91% by 6 months post-injury. For those who returned following upper limb fractures, 48% did so by 1 month post-injury, 86% by 3 months post-injury and 94% by 6 months post-injury. In patients who returned following lower limb fractures, 0% did so by 1 month post-injury, 42% by 3 months post-injury and 79% by 6 months post-injury. From the whole cohort, 32% had ongoing fracture related problems, yet only 9% had impaired rugby ability secondary to these problems. Most patients sustaining a fracture playing rugby union will return to rugby at a similar level. While one third of them will

  4. Spontaneous rib fractures. (United States)

    Katrancioglu, Ozgur; Akkas, Yucel; Arslan, Sulhattin; Sahin, Ekber


    Other than trauma, rib fracture can occur spontaneously due to a severe cough or sneeze. In this study, patients with spontaneous rib fractures were analyzed according to age, sex, underlying pathology, treatment, and complications. Twelve patients who presented between February 2009 and February 2011 with spontaneous rib fracture were reviewed retrospectively. The patients' data were evaluated according to anamnesis, physical examination, and chest radiographs. The ages of the patients ranged from 34 to 77 years (mean 55.91 ± 12.20 years), and 7 (58.4%) were male. All patients had severe cough and chest pain. The fractures were most frequently between 4th and 9th ribs; multiple rib fractures were detected in 5 (41.7%) patients. Eight (66.7%) patients had chronic obstructive pulmonary disease, 2 (16.7%) had bronchial asthma, and 2 (16.7%) had osteoporosis. Bone densitometry revealed a high risk of bone fracture in all patients. Patients with chronic obstructive pulmonary disease or bronchial asthma had been treated with high-dose steroids for over a year. Spontaneous rib fracture due to severe cough may occur in patients with osteoporosis, chronic obstructive pulmonary disease, or bronchial asthma, receiving long-term steroid therapy. If these patients have severe chest pain, chest radiography should be performed to check for bone lesions. © The Author(s) 2015.

  5. Early results of displaced supracondylar fractures of humerus in children treated by closed reduction and percutaneous pinning

    Directory of Open Access Journals (Sweden)

    Anmol Sharma


    Conclusions: Both lateral entry K-wires and lateral-trans-olecranon wire techniques provide stable fixation when observing the guidelines for wire placement and consistently satisfactory results can be obtained, both cosmetically and functionally with both the techniques.

  6. A Rare Nasal Bone Fracture: Anterior Nasal Spine Fracture

    Directory of Open Access Journals (Sweden)

    Egemen Kucuk


    Full Text Available Anterior nasal spine fractures are a quite rare type of nasal bone fractures. Associated cervical spine injuries are more dangerous than the nasal bone fracture. A case of the anterior nasal spine fracture, in a 18-year-old male was presented. Fracture of the anterior nasal spine, should be considered in the differential diagnosis of the midface injuries and also accompanying cervical spine injury should not be ignored.

  7. Hydraulic Fracture Containment in Sand

    NARCIS (Netherlands)

    Dong, Y.


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

  8. Paediatric talus fracture.

    LENUS (Irish Health Repository)

    Byrne, Ann-Maria


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

  9. Geothermal Ultrasonic Fracture Imager

    Energy Technology Data Exchange (ETDEWEB)

    Patterson, Doug [Baker-Hughes Oilfield Operation Inc., Houston, TX (United States); Leggett, Jim [Baker-Hughes Oilfield Operation Inc., Houston, TX (United States)


    The Geothermal Ultrasonic Fracture Imager project has a goal to develop a wireline ultrasonic imager that is capable of operating in temperatures up to 300°C (572°F) and depths up to 10 km (32,808 ft). This will address one of the critical needs in any EGS development of understanding the hydraulic flow paths in the reservoir. The ultrasonic imaging is well known in the oil and gas industry as one of the best methods for fracture evaluation; providing both high resolution and complete azimuthal coverage of the borehole. This enables fracture detection and characterization, both natural and induced, providing information as to their location, dip direction and dip magnitude. All of these factors are critical to fully understand the fracture system to enable the optimization of the thermal drainage through injectors and producers in a geothermal resource.

  10. Clavicle Fracture (Broken Collarbone) (United States)

    ... Bahk MS, Kuhn JE, Galatz LM, Connor PM, Williams GR: Acromioclavicular and sternoclavicular injuries and cla- vicular, ... Orthopaedic Surgeons. .org Clavicle Fracture cont. Rehabilitation Specific exercises will help restore movement and strengthen your shoulder. ...

  11. Proximal femoral fractures

    DEFF Research Database (Denmark)

    Palm, Henrik; Teixidor, Jordi


    BACKGROUND: In hip fracture surgery, the exact choice of implant often remains somewhat unclear for the individual surgeon, but the growing literature consensus has enabled publication of evidence-based surgical treatment pathways. The aim of this article was to review author pathways and national...... guidelines for hip fracture surgery and discuss a method for future pathway/guideline implementation and evaluation. METHODS: By a PubMed search in March 2015 six studies of surgical treatment pathways covering all types of proximal femoral fractures with publication after 1995 were identified. Also we...... searched the homepages of the national heath authorities and national orthopedic societies in West Europe and found 11 national or regional (in case of no national) guidelines including any type of proximal femoral fracture surgery. RESULTS: Pathway consensus is outspread (internal fixation for un...

  12. Fracture Behavior under Impact. (United States)


    discussed for the different loading rates ob- tai ned . 1. Introduction In static fracture mechanics crack tip stress intensity factors can easi- - ly...deviation to the left or to the right hand side of the original crack path was observed. Herrmann [151 speculated that this behavior results from stress...Materials’ Draft 2c, American Society for Testing and Materials, Philadelphia, .. ,-- 1980. 15. Herrmann , G., "Dynamic Fracture of Beams in Bending

  13. Relative permeability through fractures

    Energy Technology Data Exchange (ETDEWEB)

    Diomampo, Gracel, P.


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

  14. Atomistic simulations of fracture

    Energy Technology Data Exchange (ETDEWEB)

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


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

  15. Science of Fracture. (United States)


    Fracture Set-Up .............. 163 Dr. Jan T. Lindt 4.i0 Fracture in Fully Plastic Bodies ............................... 171 Dr. Howard Kuhn iii I...Benthem’s results and results obtained by 15 Bazant and Estenssoro (12) who used a finite element method of determining critical eigenvalues. Each of...14) is made by Benthem in (10) and (11) and only che sentence quoted above made by Bazant and Estenssoro (12). This is unfortunate since constructive

  16. Subduction of fracture zones (United States)

    Constantin Manea, Vlad; Gerya, Taras; Manea, Marina; Zhu, Guizhi; Leeman, William


    Since Wilson proposed in 1965 the existence of a new class of faults on the ocean floor, namely transform faults, the geodynamic effects and importance of fracture zone subduction is still little studied. It is known that oceanic plates are characterized by numerous fracture zones, and some of them have the potential to transport into subduction zones large volumes of water-rich serpentinite, providing a fertile water source for magma generated in subduction-related arc volcanoes. In most previous geodynamic studies, subducting plates are considered to be homogeneous, and there is no clear indication how the subduction of a fracture zone influences the melting pattern in the mantle wedge and the slab-derived fluids distribution in the subarc mantle. Here we show that subduction of serpentinized fracture zones plays a significant role in distribution of melt and fluids in the mantle wedge above the slab. Using high-resolution tree-dimensional coupled petrological-termomechanical simulations of subduction, we show that fluids, including melts and water, vary dramatically in the region where a serpentinized fracture zone enters into subduction. Our models show that substantial hydration and partial melting tend to concentrate where fracture zones are being subducted, creating favorable conditions for partially molten hydrous plumes to develop. These results are consistent with the along-arc variability in magma source compositions and processes in several regions, as the Aleutian Arc, the Cascades, the Southern Mexican Volcanic Arc, and the Andean Southern Volcanic Zone.

  17. Prevention of hip fractures. (United States)

    Meunier, P J


    For a 50-year old Caucasian woman today, the risk of a hip fracture over her remaining life-time is about 17%. Tomorrow the situation will clearly be worse because the continuous increase in life expectancy will cause a three-fold increase in worldwide fracture incidence over the next 60 years. Through diagnostic bone mass measurements at the hip and assessment of biochemical parameters, a great deal has been learned in recent years about reduction of hip fracture risk. Preventive strategies are based on prevention of falls, use of hip protectors, and prevention of bone fragility. The latter includes the optimization of peak bone mass during childhood, postmenopausal estrogen replacement therapy, and also late prevention consisting in reversing senile secondary hyperparathyroidism, which plays an important role in the decrease of skeletal strength. This secondary hyperparathyroidism, which results from both vitamin D insufficiency and low calcium intake, is preventable with vitamin D3 and calcium supplements. They have recently been shown capable of providing effective prevention of hip fractures in elderly women living in nursing homes, with a reduction of about 25% in the number of hip fractures noted in a 3-year controlled study in 3,270 women (intention-to-treat analysis). In conclusion, it is never too early to reduce the risk of osteoporosis and never too late to prevent hip fractures.


    Energy Technology Data Exchange (ETDEWEB)

    Subhash Shah


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

  19. [Subtrochanteric femoral fractures]. (United States)

    Ulmar, B; Simon, S; Eschler, A; Mittlmeier, T


    Subtrochanteric femoral fractures are proximal femoral fractures which are located between the trochanter minor and an area of 3 cm below the minor trochanter on the femoral shaft. About 10-15% of all proximal femoral fractures correspond to this fracture site. Elderly or geriatric patients are generally affected and the injury is often the result of a fall in the home, while high-energy trauma is the cause in a small group of generally younger patients. Clinical evaluation of the affected extremity shows disability of axial weight-bearing and pain during compression and rotation of the hip joint. Basic diagnostics include conventional x-rays of the injured femur in the anterior-posterior and lateral planes. These subtrochanteric femoral fractures are almost always treated surgically due to the inherent high degree of instability. The main goals of surgical intervention are to achieve anatomic fracture reduction and primary full weight-bearing stability of the corresponding leg. Intramedullary interlocking nails are used for primary treatment, while extramedullary implants are often used in revision surgery. Early mobilization and intensive respiratory exercises are necessary to prevent early postoperative complications.

  20. Fracture toughness of graphene. (United States)

    Zhang, Peng; Ma, Lulu; Fan, Feifei; Zeng, Zhi; Peng, Cheng; Loya, Phillip E; Liu, Zheng; Gong, Yongji; Zhang, Jiangnan; Zhang, Xingxiang; Ajayan, Pulickel M; Zhu, Ting; Lou, Jun


    Perfect graphene is believed to be the strongest material. However, the useful strength of large-area graphene with engineering relevance is usually determined by its fracture toughness, rather than the intrinsic strength that governs a uniform breaking of atomic bonds in perfect graphene. To date, the fracture toughness of graphene has not been measured. Here we report an in situ tensile testing of suspended graphene using a nanomechanical device in a scanning electron microscope. During tensile loading, the pre-cracked graphene sample fractures in a brittle manner with sharp edges, at a breaking stress substantially lower than the intrinsic strength of graphene. Our combined experiment and modelling verify the applicability of the classic Griffith theory of brittle fracture to graphene. The fracture toughness of graphene is measured as the critical stress intensity factor of and the equivalent critical strain energy release rate of 15.9 J m(-2). Our work quantifies the essential fracture properties of graphene and provides mechanistic insights into the mechanical failure of graphene.

  1. Analysis of fractures in volcanic cores from Pahute Mesa, Nevada Test Site

    Energy Technology Data Exchange (ETDEWEB)

    Drellack, S.L. Jr.; Prothro, L.B.; Roberson, K.E. [and others


    The Nevada Test Site (NTS), located in Nye County, southern Nevada, was the location of 828 announced underground nuclear tests, conducted between 1951 and 1992. Approximately one-third of these tests were detonated near or below the water table. An unavoidable consequence of these testing activities was introducing radionuclides into the subsurface environment, impacting groundwater. Groundwater flows beneath the NTS almost exclusively through interconnected natural fractures in carbonate and volcanic rocks. Information about these fractures is necessary to determine hydrologic parameters for future Corrective Action Unit (CAU)-specific flow and transport models which will be used to support risk assessment calculations for the U.S. Department of Energy, Nevada Operations Office (DOE/NV) Underground Test Area (UGTA) remedial investigation. Fracture data are critical in reducing the uncertainty of the predictive capabilities of CAU-specific models because of their usefulness in generating hydraulic conductivity values and dispersion characteristics used in transport modeling. Specifically, fracture aperture and density (spacing) are needed to calculate the permeability anisotropy of the formations. Fracture mineralogy information is used qualitatively to evaluate diffusion and radionuclide retardation potential in transport modeling. All these data can best be collected through examination of core samples.

  2. Importance of greenstick lamina fractures in low lumbar burst fractures (United States)

    Ersozlu, S.; Aydinli, U.


    Lumbar burst fractures (L3–L5) represent a small percentage of all spinal fractures. The treatment of fractures involving the lumbar spine has been controversial. Lamina fractures may be complete or of the greenstick type. Dural tears and nerve root entrapment may accompany these lamina fractures. The aim of this retrospective study was to determine the incidence of dural tear in patients who had lumbar burst fractures with greenstick lamina fractures and the importance of these lamina fractures when choosing the optimum treatment. Twenty-six patients with 28 lumbar burst fractures were treated from 1995 through 2002. The average follow-up was 60 months (range 32–110 months). The male to female ratio was 21:5 and the mean age was 37 years (17–64). Dural tear was detected in seven (25%) out of 28 burst fractures. The functional outcome of the entire study group was assessed using the Smiley-Webster Scale. Good to excellent results were obtained in 24 (92%) of 26 patients. Lumbar burst fractures with greenstick lamina fractures occur mostly in the L2–L4 area. In the surgical treatment, any reduction manoeuvre will close the fracture and crush the entrapped neural elements. Therefore, it may be better to explore the greenstick lamina fracture whether there is any neural entrapment or not, before any reduction manoeuvre is attempted. PMID:16501977

  3. Geriatric Intervention in Elderly Patients with Hip Fracture in an Orthopaedic Ward

    DEFF Research Database (Denmark)

    Gregersen, Merete; Damsgaard, Else Marie Skjøde; Hougaard, Kjeld


    Introduction: Hip fracture is a common cause of long hospital stay in the elderly. Approximately one third of these patients die within the first year. As a consequence geriatric and orthopedic col-laboration (orthogeriatrics) has been organized in different ways. The aim of this study is to eva......-luate the efficiency of a multidisciplinary geriatric in-hospital intervention on patient outcome. Methods: A total of 495 elderly hip fracture patients consecutively admitted to orthopedic surgery, were followed. Data were based on medical records. The intervention group (n=233) was com-pared to a historical cohort...... group (n=262) receiving traditional orthopedic treatment. Intervention program was based on initial physical and mental screening and evaluation, geriatric-focused care, and early discharge planning. The intervention was provided by a multidisciplinary geriatric team. After discharge, follow-up home...

  4. Complete excision of a fractured fourth metatarsal bone in eight horses. (United States)

    Baxter, G M; Doran, R E; Allen, D


    Proximal open comminuted fractures of the fourth metatarsal bone (Mt IV) in eight horses were treated by complete removal of the affected bone and antimicrobial therapy. Two horses had concurrent septic arthritis of the tarsocrural or distal tarsal articulations, and five horses had radiographic evidence of osteomyelitis and sequestration of the affected bone. Five horses became athletically sound for their intended use, two horses with septic arthritis had residual lameness but were pasture sound, and one horse was lost to follow-up. Excision of the entire bone appears to be an acceptable treatment of open comminuted fractures of the proximal one-third of Mt IV that do not respond to more conservative modes of therapy.

  5. CT of pelvic fractures

    Energy Technology Data Exchange (ETDEWEB)

    Falchi, Marco E-mail:; Rollandi, Gian Andrea


    Although magnetic resonance imaging has become the dominant modality for cross-sectional musculo-skeletal imaging, the widespread availability, speed, and versatility of computed tomography (CT) continue to make it a mainstay of emergency room (ER) diagnostic imaging. Pelvic ring and acetabular fractures occur as the result of significant trauma secondary to either a motor vehicle accident or a high-velocity fall. These injuries are correlated with significant morbidity and mortality, both from the complications of pelvic ring fractures and from commonly associated injuries. The most commonly used classification of pelvic and acetabular fractures has been based on conventional radiographs that are, in the majority of cases, sufficient to determine the type of injury. However, because of the complexity of pelvic and acetabular fractures, precise pathological anatomy is not easily demonstrated by routine radiographs and in many cases details of fractures are not visible. Moreover, the insufficient co-operation of the patient or the difficulty of maintaining special positions can be overcome by using computed tomography. Spiral computed tomography provides information regarding the extent of the fractures and is complementary to radiography for ascertaining the spatial arrangement of fracture fragments. Spiral computed tomography is an effective tool for understanding complex fracture patterns, particularly when combined with multi-planar reconstruction two-dimensional (MPR 2D) reformatted images or three-dimensional images (3D) images. Including these techniques of reconstruction in routine pelvic imaging protocols can change management in a significant number of cases. Subtle fractures, particularly those oriented in the axial plane, are better seen on MPR images or 3D volume-rendered images. Complex injuries can be better demonstrated with 3D volume-rendered images, and complicated spatial information about the relative positions of fracture fragments can be easily

  6. Physical-chemical evaluation of hydraulic fracturing chemicals in the context of produced water treatment. (United States)

    Camarillo, Mary Kay; Domen, Jeremy K; Stringfellow, William T


    Produced water is a significant waste stream that can be treated and reused; however, the removal of production chemicals-such as those added in hydraulic fracturing-must be addressed. One motivation for treating and reusing produced water is that current disposal methods-typically consisting of deep well injection and percolation in infiltration pits-are being limited. Furthermore, oil and gas production often occurs in arid regions where there is demand for new water sources. In this paper, hydraulic fracturing chemical additive data from California are used as a case study where physical-chemical and biodegradation data are summarized and used to screen for appropriate produced water treatment technologies. The data indicate that hydraulic fracturing chemicals are largely treatable; however, data are missing for 24 of the 193 chemical additives identified. More than one-third of organic chemicals have data indicating biodegradability, suggesting biological treatment would be effective. Adsorption-based methods and partitioning of chemicals into oil for subsequent separation is expected to be effective for approximately one-third of chemicals. Volatilization-based treatment methods (e.g. air stripping) will only be effective for approximately 10% of chemicals. Reverse osmosis is a good catch-all with over 70% of organic chemicals expected to be removed efficiently. Other technologies such as electrocoagulation and advanced oxidation are promising but lack demonstration. Chemicals of most concern due to prevalence, toxicity, and lack of data include propargyl alcohol, 2-mercaptoethyl alcohol, tetrakis hydroxymethyl-phosphonium sulfate, thioglycolic acid, 2-bromo-3-nitrilopropionamide, formaldehyde polymers, polymers of acrylic acid, quaternary ammonium compounds, and surfactants (e.g. ethoxylated alcohols). Future studies should examine the fate of hydraulic fracturing chemicals in produced water treatment trains to demonstrate removal and clarify interactions

  7. Campbell肘后入路鹰嘴窝钢板内固定治疗肱骨髁间骨折%Olecranon fossa Plate for the surgical treatment of intereondylar fracture of humerus through Campbell's posterior approach of elbow

    Institute of Scientific and Technical Information of China (English)

    付三清; 蒋国安; 彭科武; 高伟; 曾军



  8. CT classification of acetabular fractures

    Energy Technology Data Exchange (ETDEWEB)

    Marincek, B.; Porcellini, B.; Robotti, G.


    The contribution of computed tomography (CT) in classifying acetabular fractures was analysed retrospectively in 33 cases. CT and plain radiography classification agreed in 27 cases (82%). CT revealed more extensive fractures in 6 patients (thereof 5 patients with associated fractures). In 10 patients (thereof 9 patients with associated fractures) CT showed intraarticular fragments; radiographically intraarticular fragments were seen only in 2 patients and suspected in 4. CT is of considerable aid in defining the fracture pattern. It should be used mainly in patients with radiographically difficult interpretable associated fractures in order to assess preoperatively the weight-bearing part of the acetabulum, the degree of displacement and the presence of intraarticular fragments.

  9. Atomistic Simulations of Nanotube Fracture

    CERN Document Server

    Belytschko, T; Schatz, G; Ruoff, R S


    The fracture of carbon nanotubes is studied by atomistic simulations. The fracture behavior is found to be almost independent of the separation energy and to depend primarily on the inflection point in the interatomic potential. The rangle of fracture strians compares well with experimental results, but predicted range of fracture stresses is marketly higher than observed. Various plausible small-scale defects do not suffice to bring the failure stresses into agreement with available experimental results. As in the experiments, the fracture of carbon nanotubes is predicted to be brittle. The results show moderate dependence of fracture strength on chirality.

  10. [Humeral shaft fractures]. (United States)

    Schittko, A


    Since Lorenz Böhler postulated in his 1964 summary with the title "Against the operative treatment of fresh humeral shaft fractures" that the operative treatment is the exception in the therapy of humeral fractures times have changed. In the last years a conservative treatment of a humeral fracture is the exception and only used after straight indications. The operative therapy nowadays is the gold standard because of the development of new intramedullar and rotation stable implants in addition to the classical osteosynthesis with the plate. But even the external fixator for primary stabilisation in polytrauma patients or as rescue procedure after complications should be in repertory of every orthopedic surgeon. Attention should be put on the avoidance of primary and the correct treatment of secondary nerval lesions, esp. of the radial nerve. Here we are tending to the operative revision of the nerve in indistinct cases. In the treatment of the seldom humeral shaft fracture of the child conservative treatment is to prefer; in complications a resolute shift to a final operative stabilisation of the fracture is necessary.

  11. Fracture-Flow-Enhanced Solute Diffusion into Fractured Rock

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Yu-Shu; Ye, Ming; Sudicky, E.A.


    We propose a new conceptual model of fracture-flow-enhanced matrix diffusion, which correlates with fracture-flow velocity, i.e., matrix diffusion enhancement induced by rapid fluid flow within fractures. According to the boundary-layer or film theory, fracture flow enhanced matrix diffusion may dominate mass-transfer processes at fracture-matrix interfaces, because rapid flow along fractures results in large velocity and concentration gradients at and near fracture-matrix interfaces, enhancing matrix diffusion at matrix surfaces. In this paper, we present a new formulation of the conceptual model for enhanced fracture-matrix diffusion, and its implementation is discussed using existing analytical solutions and numerical models. In addition, we use the enhanced matrix diffusion concept to analyze laboratory experimental results from nonreactive and reactive tracer breakthrough tests, in an effort to validate the new conceptual model.

  12. Transstyloid, transscaphoid, transcapitate fracture: a variant of scaphocapitate fractures.

    LENUS (Irish Health Repository)

    Burke, Neil G


    Transstyloid, transscaphoid, transcapitate fractures are uncommon. We report the case of a 28-year-old man who sustained this fracture following direct trauma. The patient was successfully treated by open reduction internal fixation of the scaphoid and proximal capitate fragment, with a good clinical outcome at 1-year follow-up. This pattern is a new variant of scaphocapitate fracture as involves a fracture of the radial styloid as well.

  13. Vertebral Geometry Parameters Can Predict Fractures

    Directory of Open Access Journals (Sweden)

    P Tofighi


    Conclusion: Vertebral fractures are common fractures in postmenopausal women. There was a correlation between verte¬bral height and fractures. Vertebral geometric parameters especially height T score can be used for fracture screening.

  14. Galeazzi fractures and dislocations. (United States)

    Giannoulis, Filippos S; Sotereanos, Dean G


    In 1934, fractures of the middle and distal third of the radius associated with instability of the distal radial ulnar joint (DRUJ) were described by Galeazzi. This type of lesion is characterized by its unstable nature and the need for open reduction and internal fixation to achieve a satisfactory functional outcome. A high index of suspicion should be maintained by the surgeon, and a thorough examination for instability of the DRUJ must be conducted. The marked instability of this fracture-dislocation complex is further enhanced by the disruption of the triangular fibrocartilage complex, either with or without ulna styloid fracture. Treatment in adults is surgical, and both bone and soft tissue injuries should be addressed.

  15. DEM Particle Fracture Model

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Boning [Univ. of Colorado, Boulder, CO (United States); Herbold, Eric B. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Homel, Michael A. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Regueiro, Richard A. [Univ. of Colorado, Boulder, CO (United States)


    An adaptive particle fracture model in poly-ellipsoidal Discrete Element Method is developed. The poly-ellipsoidal particle will break into several sub-poly-ellipsoids by Hoek-Brown fracture criterion based on continuum stress and the maximum tensile stress in contacts. Also Weibull theory is introduced to consider the statistics and size effects on particle strength. Finally, high strain-rate split Hopkinson pressure bar experiment of silica sand is simulated using this newly developed model. Comparisons with experiments show that our particle fracture model can capture the mechanical behavior of this experiment very well, both in stress-strain response and particle size redistribution. The effects of density and packings o the samples are also studied in numerical examples.

  16. Temporary Sternoclavicular Plating for an Unusual Double Clavicle Fracture (Medial Nonunion, Lateral Acute Complicated by an Intraoperative Pneumothorax

    Directory of Open Access Journals (Sweden)

    John G. Skedros


    Full Text Available Double (segmental clavicle fractures, involving both the medial and lateral aspects of the clavicle, are very uncommon. Even less common is an asynchronous double fracture with one of the fractures being a nonunion. We report the case of a 30-year-old healthy male patient who had an unusual double clavicle fracture (medial nonunion, lateral acute that occurred in separate traumatic events during motocross (motorcycle racing. His fractures were treated surgically in two stages. In the first stage a long reconstruction plate was used that spanned onto the sternum and two transcortical screws were placed into the manubrium to enhance purchase for the deficient bone of the medial clavicle. In accordance with the preoperative plan, the medial one-third of the plate and the medial four screws (of the total 13 used were removed. Although our patient had an excellent final result, he did have an intraoperative pneumothorax that was treated uneventfully with a chest tube. Medial clavicle fractures are difficult to treat, especially if they are nonunions and surgical complication rates can be high. Our case is one of the few that has been described where temporary sternoclavicular plating was successful in achieving an excellent long-term outcome.

  17. Temporary sternoclavicular plating for an unusual double clavicle fracture (medial nonunion, lateral acute) complicated by an intraoperative pneumothorax. (United States)

    Skedros, John G; Knight, Alex N; Mears, Chad S; Langston, Tanner D


    Double (segmental) clavicle fractures, involving both the medial and lateral aspects of the clavicle, are very uncommon. Even less common is an asynchronous double fracture with one of the fractures being a nonunion. We report the case of a 30-year-old healthy male patient who had an unusual double clavicle fracture (medial nonunion, lateral acute) that occurred in separate traumatic events during motocross (motorcycle) racing. His fractures were treated surgically in two stages. In the first stage a long reconstruction plate was used that spanned onto the sternum and two transcortical screws were placed into the manubrium to enhance purchase for the deficient bone of the medial clavicle. In accordance with the preoperative plan, the medial one-third of the plate and the medial four screws (of the total 13 used) were removed. Although our patient had an excellent final result, he did have an intraoperative pneumothorax that was treated uneventfully with a chest tube. Medial clavicle fractures are difficult to treat, especially if they are nonunions and surgical complication rates can be high. Our case is one of the few that has been described where temporary sternoclavicular plating was successful in achieving an excellent long-term outcome.

  18. Complications of mandibular fractures. (United States)

    Zweig, Barry E


    Before any definitive treatment of mandibular fractures, the patient needs to be evaluated for more potentially life-threatening injuries. Complications can and do occur with treatment of mandibular fractures and can occur during any of the phases of treatment. The development of an accurate diagnosis and appropriate treatment plan is vital in achieving optimal success and decreasing complications. Knowledge of the anatomy and the principles of bone healing is also an important factor in preventing complications. To limit long-term untoward effects, complications should be recognized early and the appropriate treatment should be started before a minor complication becomes a complex one that is more difficult to manage.

  19. Fractured Petroleum Reservoirs

    Energy Technology Data Exchange (ETDEWEB)

    Firoozabadi, Dr. Abbas


    In this report the results of experiments of water injection in fractured porous media comprising a number of water-wet matrix blocks are reported for the first time. The blocks experience an advancing fracture-water level (FWL). Immersion-type experiments are performed for comparison; the dominant recovery mechanism changed from co-current to counter-current imbibition when the boundary conditions changed from advancing FWL to immersion-type. Single block experiments of co-current and counter-current imbibition was performed and co-current imbibition leads to more efficient recovery was found.

  20. [Supracondylar fractures in children]. (United States)

    Petrov, N; Gucev, S; Kirkov, Lj; Dajljevik, S; Ruso, B


    In the Department of Pediatric surgery, during the last ten years, 190 patients with supracondylar fractures (second and third degree, according to Bauman's classification) have been treated. The operation was performed in only 5% of all hospitalized cases. There were only one patient with neurological and vascular complications in the early stage, but without any complications in the late stage. The presented cases showed a high percentage of flexion type of fractures. The conservative treatment by a reposition has given the most satisfactory results.

  1. Distal Radius Fracture (Broken Wrist) (United States)

    .org Distal Radius Fracture (Broken Wrist) Page ( 1 ) The radius is the larger of the two bones of the forearm. The ... the distal end. A fracture of the distal radius occurs when the area of the radius near ...

  2. Colles wrist fracture – aftercare (United States)

    ... . Prawer A. Radius and ulna fractures. In: Eiff MP, Hatch RL, eds. Fracture Management for Primary Care . 3rd ed. Philadelphia, PA: Elsevier Saunders; 2011:chap ...

  3. Fracture After Total Hip Replacement (United States)

    ... osteolysis. Symptoms The most common symptoms of periprosthetic hip fracture include: • Pain around the hip or thigh • Swelling ... o en very painful, someone with a periprosthetic hip fracture will most likely go directly to the emergency ...

  4. Y型锁定钢板置入治疗成人肱骨髁间骨折36例%Y-type locking plate for intercondylar fractures of the adult hunmerus in 36 cases

    Institute of Scientific and Technical Information of China (English)

    程煜方; 魏忠民; 黄方敏; 张克良; 李子熙


    背景:肱骨髁间骨折是一种复杂的关节内骨折,骨折端的显露及固定均比较困难.目的:观察经尺骨鹰嘴截骨入路Y型解剖型锁定钢板治疗肱骨髁间骨折的效果.方法:采用尺骨鹰嘴截骨入路,Y型解剖型锁定钢板治疗肱骨髁间骨折36例,男22例,女14例,年龄19-76岁,平均47岁,按AO/OTA分型:C1型8例,C2型15例,C3型13例.结果与结论:32例获得随访,随访时间为10~26个月.用改良的Cassebaum评分标准评分,优15例,良13例,中3例,差1例,优良率89.6%.尺骨鹰嘴截骨入路切口无一例感染,骨折愈合时间为2.5~4.5个月,平均3.5个月.固定后钢板未出现松动现象.结果显示用尺骨鹰嘴截骨入路Y型解削型锁定钢板治疗肱骨髁间骨折,显露范围广,固定牢靠,能有效防止骨折不愈合,可指导患者早期在CPM机上进行肘关节功能锻炼,肘关节功能恢复良好,是治疗肱骨髁间骨折的有效方法.%BACKGROUND: Jnlercondylar fracture of the humerus is a hind of complex intra-articular fractures. Fracture exposure andfixation are difficult.OBJECTIVE: To explore the surgical effect of Y-type locking plate through the approach of olecranon osterolomy onintercondylar fracture of Ihe adult humerus.METHODS: Thirty-six adult patients with intercondylar fractures of the hunmerus were treated with Y-type locking plale Ihroughthe approach of olecranon osterotomy. Including 22 mates and 14 females, aged 19-76 years. Averagely47year. According lothe AO/OTA dassificaiton. Type C1 fracture was found in 8 cases, type C2 in 15, and type C3 in 13.RESULTS AND CONCLUSION: Thirty-two cases received a follow-up of 10-26 months. According to Cassebaum scale, thefunction of the elbow showed excellent in 15 cases, good in 13 cases, fair in 3 cases and poor in 1 case, and the excellent-goodrate was 89.6%. No infection occurred. The mean time for fracture healing was 2.4 to 4.5 months, averagely 3.5 months. Thetechnique of Y-type locking plate for

  5. Microcracks and Overpressure- Induced Fractures

    Institute of Scientific and Technical Information of China (English)

    Ahmed M. Al - QAHTANI


    The microfractures and natural fractures studies have a great significance in the hydrocarbon accumulation exploration and can be a good supporter for wide geophysical study on the major structures. This paper is a brief review on microcracks and overpressure- induced fracture. It is to discuss different views on the mechanism of fractures in the subsurface of the earth.

  6. Fracture design modelling

    Energy Technology Data Exchange (ETDEWEB)

    Crichlow, H.B.; Crichlow, H.B. (ed.)


    A design tool is discussed whereby the various components that enter the design process of a hydraulic fracturing job are combined to provide a realistic appraisal of a stimulation job in the field. An interactive computer model is used to solve the problem numerically to obtain the effects of various parameters on the overall behavior of the system.

  7. Forearm Fractures in Children (United States)

    ... secure them in place. Your doctor may recommend surgery if: Casts support and protect broken bones while they heal. Reproduced from Pring M, Chambers H: Pediatric forearm fractures. Orthopaedic Knowledge Online Journal 2007; 5(5). Accessed October 2014. • The bone ...

  8. Fracture Toughness Characterization

    Directory of Open Access Journals (Sweden)

    Manuel Beltrán Z


    Full Text Available This paper addresses the fracture toughness ( , or also known as critical stress intensity Factor, according to conditions of Lineal Elastic Fracture Mechanics (LEFM. The characterization of the mechanical properties in tensile and fracture toughness of structural steel pipes API-5L used in hydrocarbons transportation was performed. For fracture toughness, the material was tested through fatigue crack propagation on standardized compact specimen (CT according to ASTM E-399 norm. A thickness (B equal to and a crack size (a equal to 0.5w were used. With the porpoise of establishing the adequate conditions at the crack tip, the specimens were subjected to fatigue pre-cracking by application of repeated cycles of load in tensile-tensile and constant load amplitude with a load ratio of R = 0.1. The experimental Compliance method was used based on data obtained from load vs. Crack Mouth Opening Displacement (CMOD. The results show a Stress Intensity factor of 35.88 MPa√m for a 25 mm crack size specimen. The device used for testing is a MTS-810 machine with capacity of 100KN and 6 kHz sampling rate, which meets the conditions of the ASTM E-399 standard. The cracking susceptibility of steel is influenced by the size, morphology and distribution of non-metallic inclusions, thermochemical interaction with the environment and microstructure.

  9. Neglected hangman fracture

    Directory of Open Access Journals (Sweden)

    Sudhir Kumar Srivastava


    Full Text Available Acute management of hangman fracture is well described; however the surgical management of neglected hangman fracture has not been described in literature. We report the surgical management of an untreated hangman′s fracture. A 30-year-old male had fallen from a tree 12 weeks back. Patient presented with cervical myelopathy and restricted neck movements. Radiographs and computed tomography (CT scan revealed fracture of pars interarticularis of axis with Grade III C2-C3 spondylolisthesis with localized kyphosis of 33°. Gentle reduction under general anesthesia (GA failed to improve the alignment. Patient was operated in three stages in a single setting. In Stage I, release of contracted anterior structures and C2-C3 discectomy was done in supine position followed by C2-C3 posterior fixation and fusion in Stage II. C2-C3 interbody bone grafting and anterior plating completed the third stage. C2-C3 interbody fusion was seen at 5 months and a CT scan at 18 months postoperative confirmed fusion and maintenance of alignment. The satisfactory outcome in our patient leads us to believe that anterior-posterior-anterior is the appropriate surgical approach for treatment of such patients.

  10. Injection through fractures

    Energy Technology Data Exchange (ETDEWEB)

    Johns, R.A.


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

  11. Fracture Mechanics of Concrete

    DEFF Research Database (Denmark)

    Ulfkjær, Jens Peder

    Chapter 1 Chapter l contains the introduction to this thesis. The scope of the thesis is partly to investigate different numerical and analytical models based on fracture mechanical ideas, which are able to predict size effects, and partly to perform an experimental investigation on high-strength......Chapter 1 Chapter l contains the introduction to this thesis. The scope of the thesis is partly to investigate different numerical and analytical models based on fracture mechanical ideas, which are able to predict size effects, and partly to perform an experimental investigation on high......-strength concrete. Chapter 2 A description of the factors which influence the strength and cracking of concrete and high strength concrete is made. Then basic linear fracture mechanics is outlined followed by a description and evaluation of the models used to describe concrete fracture in tension. The chapter ends...... with a description of the different types of size effects. Three examples which discuss the two terms 'size effect' and 'brittleness' and the importance of a stiff test rig. Finally some brittleness numbers are defined. Chapter 3 In chapter 3 the most well-known numerical methods which use the fictitious crack...

  12. Correlation of hip fracture with other fracture types: Toward a rational composite hip fracture endpoint. (United States)

    Colón-Emeric, Cathleen; Pieper, Carl F; Grubber, Janet; Van Scoyoc, Lynn; Schnell, Merritt L; Van Houtven, Courtney Harold; Pearson, Megan; Lafleur, Joanne; Lyles, Kenneth W; Adler, Robert A


    With ethical requirements to the enrollment of lower risk subjects, osteoporosis trials are underpowered to detect reduction in hip fractures. Different skeletal sites have different levels of fracture risk and response to treatment. We sought to identify fracture sites which cluster with hip fracture at higher than expected frequency; if these sites respond to treatment similarly, then a composite fracture endpoint could provide a better estimate of hip fracture reduction. Cohort study using Veterans Affairs and Medicare administrative data. Male Veterans (n=5,036,536) aged 50-99 years receiving VA primary care between 1999 and 2009 were included. Fractures were ascertained using ICD9 and CPT codes and classified by skeletal site. Pearson correlation coefficients, logistic regression and kappa statistics were used to describe the correlation between each fracture type and hip fracture within individuals, without regard to the timing of the events. 595,579 (11.8%) men suffered 1 or more fractures and 179,597 (3.6%) suffered 2 or more fractures during the time under study. Of those with one or more fractures, the rib was the most common site (29%), followed by spine (22%), hip (21%) and femur (20%). The fracture types most highly correlated with hip fracture were pelvic/acetabular (Pearson correlation coefficient 0.25, pfractures cluster with hip fractures within individuals at greater than expected frequency. If we observe similar treatment risk reductions within that cluster, subsequent trials could consider the use of a composite endpoint to better estimate hip fracture risk. Published by Elsevier Inc.

  13. Fracture strength of root filled premolar teeth restored with silorane and methacrylate-based resin composite. (United States)

    Taha, N A; Maghaireh, G A; Bagheri, R; Abu Holy, A


    To compare fracture characteristics of root-filled teeth with variable cavity design restored with a low shrinkage silorane and methacrylate-based resin composite. 77 extracted maxillary premolars were divided randomly into seven groups: (Group 1) intact teeth; (Groups 2-4) MOD plus endodontic access with the buccopalatal width of the occlusal isthmus equals one third of the intercuspal width; (Groups 5-7) MOD plus endodontic access with the buccopalatal width of the occlusal isthmus equals one half of the intercuspal width. Groups 2 and 5 were left unrestored, Groups 3 and 6 were restored with a silorane-based resin composite (Filtek P90) and Groups 4 and 7 with a methacrylate-based resin composite (Z250). Teeth were loaded in a universal testing machine; load and fracture patterns were recorded and compared statistically using 2-way ANOVA and t-test for pairwise comparisons and 1-way ANOVA with Dunnett test for multiple comparisons. Unrestored teeth became progressively weaker with more extensive preparations, Group 5 (unfilled ½) showed the lowest fracture load among the groups (71±22N, Presin composite have no superior strengthening effect over the conventional methacrylate-based resin composite in restoration of root filled teeth. Both materials showed similar fracture patterns. Root filled teeth are considerably weakened via restorative and endodontic procedures. A direct adhesive restoration will aid in preserving tooth structure as far as it provides enough strength. Copyright © 2015 Elsevier Ltd. All rights reserved.


    Directory of Open Access Journals (Sweden)

    Đivo Ban


    Full Text Available Children and adolescents today, all before starting with regular sports activities and involvement in semi-professional and top professional sport, so it increases the num- ber of discovered stress fractures in this age. This type of injury can occur as a consequence of action one strong force, or the many repeated small force strength, to be exact, when the load (stress transcend ability reparations bones. Stress fractures are recorded and described up to the lower limbs. Research has been confirmed that the bones of lower leg are mostly made in injury, and with the el- derly and with the population of children and young adolescents. Occur in many sports, something to them is greater when the frequency of running and often are present in the female population. According to the results of numerous investigations, mistakes in the training are the most common cause of the emergence of stress fracture. In a direct comparison with complemented these injuries is the condition of muscles, so it is important that at the sa- me time carry out exercises strengthen muscles and stretching. Typical clinical signs of stress fractures are localized painful sensitivity to palpa- tion and runoff in a small number of cases. The basic diagnostic procedure is a medical check, it is the small, radiology and scintigraphyc diagnostics (most accurate and mag- netic resonance imaging. Treatment is usually without surgery and conservative, with rest and reducing stress, and its activity athlete breaks mainly between four and eight weeks. Only the very need surgical treatment The most important thing is that attention is focused on the proper prevention and to take all that it ever occurred to stress fractures that athletes ramble of the courts and the competition (better education of sports workers, separation of groups with increa- sed risk of the formation of an injury, adaptation activities age and abilities of athletes, adequate sports equipment, high-quality sports

  15. Diplopia and orbital wall fractures. (United States)

    Boffano, Paolo; Roccia, Fabio; Gallesio, Cesare; Karagozoglu, K Hakki; Forouzanfar, Tymour


    Diplopia is a symptom that is frequently associated with orbital wall fractures. The aim of this article was to present the incidence and patterns of diplopia after orbital wall blow-out fractures in 2 European centers, Turin and Amsterdam, and to identify any correlation between this symptom and such fractures. This study is based on 2 databases that have continuously recorded data of patients hospitalized with maxillofacial fractures between 2001 and 2010. On the whole, 447 patients (334 males, 113 females) with pure blow-out orbital wall fractures were included. The most frequently involved orbital site was the floor (359 fractures), followed by medial wall (41 fractures) and lateral wall (5 fractures). At presentation, 227 patients (50.7%) had evidence of diplopia. In particular, in most patients, a diplopia in all directions was referred (78 patients). Statistically significant associations were found between diplopia on eye elevation and orbital floor fractures (P diplopia and medial wall fractures (P diplopia on eye elevation and horizontal diplopia at presentation could be useful clinical indicators orbital floor and medial wall fractures, respectively.

  16. Scaphoid fractures in the athlete. (United States)

    Winston, Mark J; Weiland, Andrew J


    Scaphoid fractures are a common wrist injury, especially in athletes. Clinicians should have a high index of suspicion for a scaphoid fracture in any patient complaining of radial-sided wrist pain after a fall on an outstretched hand. Advanced imaging, including CT and MRI scans, may be useful in diagnosis and classification of fracture patterns. Treatment varies based on the fracture location, stability of the fracture, and predictability of the fracture to heal. Treatment involves either non-operative management with a thumb spica cast or brace, or operative fixation with a headless compression screw, k-wires, or scaphoid-specific plates. Return to play is dependent on many variables, including sport, fracture union, and ability to play with cast.

  17. Collagen turnover after tibial fractures

    DEFF Research Database (Denmark)

    Joerring, S; Krogsgaard, M; Wilbek, H


    Collagen turnover after tibial fractures was examined in 16 patients with fracture of the tibial diaphysis and in 8 patients with fracture in the tibial condyle area by measuring sequential changes in serological markers of turnover of types I and III collagen for up to 26 weeks after fracture...... collagen. A group comparison showed characteristic sequential changes in the turnover of types I and III collagen in fractures of the tibial diaphysis and tibial condyles. The turnover of type III collagen reached a maximum after 2 weeks in both groups. The synthesis of type I collagen reached a maximum...... after 2 weeks in the diaphyseal fractures and after 6 weeks in the condylar fractures. The degradation of type I collagen increased after 4 days and reached a maximum at 2 weeks in both groups. The interindividual variation was wide. On a group basis, the turnover of types I and III collagen had...

  18. Periprosthetic fractures evaluation and treatment. (United States)

    Masri, Bassam A; Meek, R M Dominic; Duncan, Clive P


    Periprosthetic fracture is a serious complication of total hip arthroplasty (THA) that can be difficult to treat, and can be potentially fraught with complications. The incidence of such fractures is increasing, especially after the use of cementless revision arthroplasty. The prevention of these fractures is achieved by understanding the risk factors involved. If the risks are not understood, the best outcome is achieved when the surgeon has a thorough understanding of the principles of treatment of these fractures and has access to various fixation and prosthetic devices, and allograft bone when necessary. Acetabular fractures are rare and relatively little has been reported on their treatment. Periprosthetic femoral fracture treatment is based on the site of fracture, implant stability, and bone stock. The Vancouver classification offers a reproducible description of these factors with the subsequently easy formation of a treatment plan.

  19. Hydraulic fracture propagation modeling and data-based fracture identification (United States)

    Zhou, Jing

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

  20. Osteoporosis-Related Health Services Utilization Following First Hip Fracture Among a Cohort of Privately-Insured Women in the United States, 2008-2014: An Observational Study. (United States)

    Gillespie, Catherine W; Morin, Pamela E


    Timely identification and treatment of osteoporosis following hip fracture is recommended to mitigate future fracture risk, yet prior work has demonstrated a disconnect between evidence-based recommendations and real-world implementation. We sought to describe contemporary patterns of osteoporosis screening and initiation of pharmacotherapy following hip fracture based on medical and pharmacy claims in the OptumLabs™ Data Warehouse. From a national sample, we identified 8349 women aged 50+ years enrolled in private commercial or Medicare Advantage plans with no prior history of osteoporosis diagnosis, osteoporosis pharmacotherapy, or hip fracture who experienced a hip fracture between 2008 and 2013. Just 17.1% and 23.1% of these women had evidence of osteoporosis assessment and/or treatment within 6 or 12 months of their fractures, respectively. Women aged 80+ years were one-third less likely to utilize recommended services within 6 months, compared to those aged 50 to 79 years (13.8% versus 20.8%; p measurement increased significantly among women aged 65+ years over the study period (p Accounting for differences in all measured characteristics, receipt of primary care was the strongest and most consistent predictor of osteoporosis assessment or treatment following fracture. © 2017 American Society for Bone and Mineral Research.

  1. Outcome after pin fixation of supracondylar humerus fractures in children: postoperative radiographic examinations are unnecessary (United States)

    Tuomilehto, Noora; Kivisaari, Reetta; Sommarhem, Antti; Nietosvaara, Aarno Y


    Background and purpose — The quality of pin fixation of displaced supracondylar humerus fractures in children has not been assessed, and the clinical value of radiographic examinations after pin fixation is unclear. We evaluated pin configuration, quality of osteosynthesis, and outcome in 264 supracondylar fractures. The clinical significance of postoperative radiographs was analyzed. Patients and methods — 252 Gartland-III and 12 flexion-type supracondylar humerus fractures were pin-fixed in the periods 2002–2006 and 2012–2014. During 2012–2014, staff were intructed that postoperative radiographs should not be taken. Quality of reduction was assessed by measuring Baumann and lateral capitellohumeral angles (LCHA) and also by recording the crossing point of the anterior humeral line (AHL) with bony capitellum. Rotatory alignment was registered as normal or abnormal. Pin configuration and quality of osteosynthesis were evaluated. The clinical significance of postoperative radiographs was analyzed. Results — Postoperatively, Baumann angle was normal in 66% of the fractures, AHL crossed the capitellum in 84%, and no malrotation was evident in 85% of the fractures. Crossed pins were used in 89% of the cases. 2 or more pins fixed both fracture fragments in 66%. Radiographic examinations were inadequate for assessment of LCHA in 13%, of Bauman angle in 8%, of AHL in 2%, of rotation in 1%, and of pin fixation in 2% of the cases. Postoperative radiographs did not give useful information except in 1 patient who had corrective osteotomy. All 94 patients with follow-up (97%) who were treated during 2012–2014 were satisfied with the outcome. Interpretation — Despite pin fixation being deemed unsatisfactory in one-third of the cases, significant malunion was rare. Postoperative radiography did not alter management or outcome. PMID:27774833

  2. Access to Anti-osteoporosis Medication after Hip Fracture in Korean Elderly Patients. (United States)

    Yu, Yun Mi; Lee, Ju-Yeun; Lee, Euni


    This study aims to evaluate access to anti-osteoporosis medication (AOM) and the factors affecting their prescription for Korean elderly patients with a hip fracture. A cross-sectional study was conducted on hip fracture patients aged 65 years or more using national-level data from 2013 to 2014. The prescription rates of AOM within 3 months after hip fracture were determined and the factors affecting AOM prescriptions were identified through multivariate logistic regression. A total of 6307 elderly patients were selected from a national medical insurance database, giving an estimated 15,768 patients nationally in a nine-month period. One-third of the patients (33.5%) received an AOM prescription and only 9.4% of the patients were prescribed an AOM with calcium and vitamin D supplements. Being 80 years and older (adjusted OR, 0.78; 95% CI, 0.70-0.88) and having three or more comorbid diseases (adjusted OR, 0.66; 95% CI, 0.55-0.78) were associated with a lower likelihood of an AOM prescription. Female sex (adjusted OR, 2.54; 95% CI, 2.17-2.98), an osteoporosis diagnosis (adjusted OR, 2.50; 95% CI, 2.15-2.91), concurrent thiazolidinedione therapy (adjusted OR, 2.11; 95% CI, 1.29-3.45) and a dual-energy X-ray absorptiometry (DXA) examination after hip fracture (adjusted OR 4.11; 95% CI, 3.67-4.62) were all significant predictive factors for AOM prescription. Bisphosphonates were the most frequently prescribed AOMs (92.2%). The AOM prescription rate for elderly patients with hip fractures was suboptimal in Korea. Factors affecting an AOM prescription were age, sex, clinical comorbidity, osteoporosis status, concurrent thiazolidinedione therapy, and receiving a DXA examination after hip fracture. Copyright © 2017. Published by Elsevier B.V.


    Directory of Open Access Journals (Sweden)

    Pradeep Chandra


    Full Text Available As one-third of the tibial surface is subcutaneous throughout its length, open fractures are commonly encountered in this bone. The factors which determine the outcome of these fractures are severity of the injury, indicated by the degree of initial displacement, comminution and soft tissue injury and the damage to the tibial blood supply. In open fractures not only is the endosteal circulation disrupted but also the periosteal circulation, because of periosteal stripping. The various available options of treatment such as conservative short leg or long leg casting, open reduction and internal fixation with plates and screws, intramedullary fixation (Including Ender pins, Intramedullary nails and Interlocking Intramedullary nails with reaming or without reaming and external fixation techniques have their own advantages and disadvantages. The present study was conducted in the Department of Orthopaedics, Gandhi Hospital, during the period from October 2013 to November 2015, to evaluate the results of internal fixation with interlocking intramedullary nailing without reaming in the treatment of the open fractures of tibia. In our study, we got 91% good-to-excellent results evaluated by Johner and Wruh criteria. We opine that closed unreamed interlocking intramedullary nailing yields good-to-excellent results in compound diaphyseal fractures of the tibia, as this technique allows a good control over the rotations with axial stability of the fracture, thus maintaining the length of the limb and enabling early joint motion. The endosteal blood supply is also well preserved. These factors help in lowering the rates of infection, malunions and non-unions.

  4. Fracture of sandwiched composites

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Weh-Huei.


    Fracture of a pair of collinear cracks in various materials, such as an isotropic strip, an orthotropic strip, a bonded isotropic adhesive layer, and sandwiched orthotropic layers, is investigated. The crack surfaces are subjected to an arbitrary opening pressure p(x). The problems are formulated in terms of Fredholm integral equation of the second kind by making use the techniques of Fourier transform and finite Hilbert transform. In case of uniform opening pressure p(x)={sigma}, exact expressions for the stress intensity factors and the shape of deformed crack are obtained. Numerical calculations are carried out to study the effects of various boundary geometries and material properties on the fracture of the chosen materials.


    Directory of Open Access Journals (Sweden)

    Deepak Kaladagi


    Full Text Available BACKGROUND: The incidence of humeral fracture has significantly increased during the present years due to the population growth and road traffic, domestic, industrial, automobile accidents & disasters like tsunami, earthquakes, head-on collisions, polytrauma etc. In order to achieve a stable fixation followed by early mobilization, numerous surgical implants have been devised. PURPOSE: The purpose of this study is to analyze the results of intramedullary fixation of proximal 2/3rd humeral shaft fractures using an unreamed interlocking intramedullary nail. INTRODUCTION: In 40 skeletally matured patients with fracture shaft of humerus admitted in our hospital, we used unreamed antegrade interlocking nails. MATERIAL: We carried out a prospective analysis of 40 patients randomly selected between 2001 to 2014 who were operated at JNMC Belgaum, MMC Mysore & Navodaya Medical College, Raichur. All cases were either RTAs, Domestic, Industrial, automobile accidents & also other modes of injury. METHOD: Routine investigations with pre-anaesthetic check-up & good quality X-rays of both sides of humerus was taken. Time of surgery ranged from 5-10 days from the time of admission. Only upper 1/3rd & middle 1/3rd humeral shaft fractures were included in the study. In all the cases antegrade locked unreamed humeral nails were inserted under C-arm. Patient was placed in supine position & the shoulder was kept elevated by placing a sandbag under the scapula. In all patients incision taken from tip of acromion to 3cm over deltoid longitudinally. Postoperatively sling applied with wrist & shoulder movements started after 24 hours. All the patients ranged between the age of 21-50 years. RESULTS: Total 40 patients were operated. Maximum fracture site were in the middle third- 76%, 14% upper 1/3rd. All 40 patients achieved union. The average time of union was 8-10 weeks. All patients regained full range of movements except in few cases, where there was shoulder

  6. Fracture of brittle solids

    CERN Document Server

    Lawn, Brian


    This is an advanced text for higher degree materials science students and researchers concerned with the strength of highly brittle covalent-ionic solids, principally ceramics. It is a reconstructed and greatly expanded edition of a book first published in 1975. The book presents a unified continuum, microstructural and atomistic treatment of modern day fracture mechanics from a materials perspective. Particular attention is directed to the basic elements of bonding and microstructure that govern the intrinsic toughness of ceramics. These elements hold the key to the future of ceramics as high-technology materials--to make brittle solids strong, we must first understand what makes them weak. The underlying theme of the book is the fundamental Griffith energy-balance concept of crack propagation. The early chapters develop fracture mechanics from the traditional continuum perspective, with attention to linear and nonlinear crack-tip fields, equilibrium and non-equilibrium crack states. It then describes the at...

  7. Tibial shaft fracture

    DEFF Research Database (Denmark)

    Larsen, Peter

    IV also showed a significant worse outcome in 3 of the 5 KOOS subscales compared to a reference population at 12-months follow-up. Moreover, this study showed that increasing difference in muscle strength for knee extension between legs was associated with a decreasing QOL. The results of this thesis...... suggested that regaining pre injured QOL and muscle strength following a tibial shaft fracture takes considerable time....

  8. Phase Field Fracture Mechanics.

    Energy Technology Data Exchange (ETDEWEB)

    Robertson, Brett Anthony [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)


    For this assignment, a newer technique of fracture mechanics using a phase field approach, will be examined and compared with experimental data for a bend test and a tension test. The software being used is Sierra Solid Mechanics, an implicit/explicit finite element code developed at Sandia National Labs in Albuquerque, New Mexico. The bend test experimental data was also obtained at Sandia Labs while the tension test data was found in a report online from Purdue University.

  9. Haemodynamically Unstable Pelvic Fractures (United States)


    through the pubic symphysis, and posteriorlywith the sacrum forming the sacroiliac (SI) joints (Fig. 1). The SI joints are the strongest in the body...Gardner MJ, Kendoff D, Ostermeier S, et al. Sacroiliac joint compression using an anterior pelvic compressor: a mechanical study in synthetic bone. J...commonly identified at arteriography.35 Posterior fracture along the SI joints may cause disruption of a main iliac trunk, but is rare, occurring less

  10. Zoledronic acid and clinical fractures and mortality after hip fracture

    DEFF Research Database (Denmark)

    Lyles, Kenneth W; Colón-Emeric, Cathleen S; Magaziner, Jay S


    BACKGROUND: Mortality is increased after a hip fracture, and strategies that improve outcomes are needed. METHODS: In this randomized, double-blind, placebo-controlled trial, 1065 patients were assigned to receive yearly intravenous zoledronic acid (at a dose of 5 mg), and 1062 patients were...... assigned to receive placebo. The infusions were first administered within 90 days after surgical repair of a hip fracture. All patients (mean age, 74.5 years) received supplemental vitamin D and calcium. The median follow-up was 1.9 years. The primary end point was a new clinical fracture. RESULTS......: The rates of any new clinical fracture were 8.6% in the zoledronic acid group and 13.9% in the placebo group, a 35% risk reduction with zoledronic acid (P=0.001); the respective rates of a new clinical vertebral fracture were 1.7% and 3.8% (P=0.02), and the respective rates of new nonvertebral fractures...

  11. Double segmental tibial fractures - an unusual fracture pattern

    Directory of Open Access Journals (Sweden)

    Bali Kamal


    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

  12. Opportunistic Identification of Vertebral Fractures. (United States)

    Adams, Judith E


    Vertebral fractures are powerful predictors of future fracture, so, their identification is important to ensure that patients are commenced on appropriate bone protective or bone-enhancing therapy. Risk factors (e.g., low bone mineral density and increasing age) and symptoms (back pain, loss of height) may herald the presence of vertebral fractures, which are usually confirmed by performing spinal radiographs or, increasingly, using vertebral fracture assessment with dual-energy X-ray absorptiometry scanners. However, a large number (30% or more) of vertebral fractures are asymptomatic and do not come to clinical attention. There is, therefore, scope for opportunistic (fortuitous) identification of vertebral fractures from various imaging modalities (radiographs, computed tomography, magnetic resonance imaging, and radionuclide scans) performed for other clinical indications and which include the spine in the field of view, with midline sagittal reformatted images from computed tomography having the greatest potential for such opportunistic detection. Numerous studies confirm this potential for identification but consistently find underreporting of vertebral fractures. So, a valuable opportunity to improve the management of patients at increased risk of future fracture is being squandered. Educational training programs for all clinicians and constant reiteration, stressing the importance of the accurate and clear reporting of vertebral fractures ("you only see what you look for"), can improve the situation, and automated computer-aided diagnostic tools also show promise to solve the problem of this underreporting of vertebral fractures. Copyright © 2016. Published by Elsevier Inc.

  13. Fracture Networks in Sea Ice

    Directory of Open Access Journals (Sweden)

    Jonas Nesland Vevatne


    Full Text Available Fracturing and refreezing of sea ice in the Kara sea are investigated using complex networkanalysis. By going to the dual network, where the fractures are nodes and their intersectionslinks, we gain access to topological features which are easy to measure and hence comparewith modeled networks. Resulting network reveal statistical properties of the fracturing process.The dual networks have a broad degree distribution, with a scale-free tail, high clusteringand efficiency. The degree-degree correlation profile shows disassortative behavior, indicatingpreferential growth. This implies that long, dominating fractures appear earlier than shorterfractures, and that the short fractures which are created later tend to connect to the longfractures.The knowledge of the fracturing process is used to construct growing fracture network (GFNmodel which provides insight into the generation of fracture networks. The GFN model isprimarily based on the observation that fractures in sea ice are likely to end when hitting existingfractures. Based on an investigation of which fractures survive over time, a simple model forrefreezing is also added to the GFN model, and the model is analyzed and compared to the realnetworks.

  14. Fracture toughness testing of V-4Cr-4Ti at 25{degrees}C and -196{degrees}C

    Energy Technology Data Exchange (ETDEWEB)

    Li, H.X.; Kurtz, R.J. [Pacific Northwest National Lab., Richland, WA (United States)


    Measurements of the fracture toughness of the production-scale heat (832665) of V-4Cr-4Ti have been performed at 25{degrees}C and {minus}196{degrees}C using compact tension (CT) specimens. Test specimens were vacuum annealed at either 1000{degrees}C for 1 hour (HT1) or 1050{degrees}C for two hours (HT2). Specimens given the HT1 treatment were annealed after final machining, whereas the HT2 specimens received the 1050{degrees}C anneal at Teledyne Wah Chang prior to final machining. Following machining HT2 specimens were then vacuum annealed at 180{degrees}C for two hours to remove hydrogen. Specimens treated using HT1 had a partially recrystallized microstructure and those treated using HT2 had a fully recrystallized microstructure. The fracture toughness at 25{degrees}C was determined by J-integral tests and at {minus}196{degrees}C by ASTM E 399 type tests. Toughness values obtained at {minus}196{degrees}C were converted to J-integral values for comparison to the 25{degrees}C data. The 25{degrees}C fracture toughness was very high with none of the specimens giving valid results per ASTM criteria. Specimens fractured by microvoid coalescence. The fracture toughness at {minus}196{degrees}C was much lower than that at 25{degrees}C and the fracture surface showed predominantly cleavage features. The present results show a transition from ductile to brittle behavior with decreasing test temperature which is not observed from one-third scale Charpy impact tests. The fracture toughness at {minus}196{degrees}C was still quite high, however, at about 75 kJ/m{sup 2}. Delaminations in planes normal to the thickness direction were seen at both test temperatures. Fracture surfaces inside the delaminations exhibited nearly 100% cleavage facets. The cause of the brittle delaminations was not determined, but will be a subject for further investigation.

  15. A Biomechanical Comparison of Locking Versus Conventional Plate Fixation for Distal Fibula Fractures in Trimalleolar Ankle Injuries. (United States)

    Nguyentat, Annie; Camisa, William; Patel, Sandeep; Lagaay, Pieter


    Previous biomechanical studies have advocated the use of locking plates for isolated distal fibula fractures in osteoporotic bone. Complex rotational ankle injuries involve an increased number of fractures, which can result in instability, potentially requiring the same fixed angle properties afforded by locking plates. However, the mechanical indication for locking plate technology has not been tested in this fracture model. The purpose of the present study was to compare the biomechanical properties of locking and conventional plate fixation for distal fibula fractures in trimalleolar ankle injuries. Fourteen (7 matched pairs) fresh-frozen cadaver leg specimens were used. The bone mineral density of each was obtained using dual x-ray absorptiometry scans. The fracture model simulated an OTA 44-B3.3 fracture. The syndesmosis was not disrupted. Each fracture was fixated in the same fashion, except for the distal fibula plate construct: locking (n = 7) and one-third tubular (n = 7). The specimens underwent axial and torsional cyclic loading, followed by torsional loading to failure. No statistically significant differences were found between the locking and conventional plate constructs during both fatigue and torque to failure testing (p > .05). Our specimen bone mineral density averages did not represent poor bone quality. The clinical implication of the present study is that distal fibular locking plates do not provide a mechanical advantage for trimalleolar ankle injuries in individuals with normal bone density and in the absence of fracture comminution. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Fractures of the cervical spine

    Directory of Open Access Journals (Sweden)

    Raphael Martus Marcon


    Full Text Available OBJECTIVES: The aim of this study was to review the literature on cervical spine fractures. METHODS: The literature on the diagnosis, classification, and treatment of lower and upper cervical fractures and dislocations was reviewed. RESULTS: Fractures of the cervical spine may be present in polytraumatized patients and should be suspected in patients complaining of neck pain. These fractures are more common in men approximately 30 years of age and are most often caused by automobile accidents. The cervical spine is divided into the upper cervical spine (occiput-C2 and the lower cervical spine (C3-C7, according to anatomical differences. Fractures in the upper cervical spine include fractures of the occipital condyle and the atlas, atlanto-axial dislocations, fractures of the odontoid process, and hangman's fractures in the C2 segment. These fractures are characterized based on specific classifications. In the lower cervical spine, fractures follow the same pattern as in other segments of the spine; currently, the most widely used classification is the SLIC (Subaxial Injury Classification, which predicts the prognosis of an injury based on morphology, the integrity of the disc-ligamentous complex, and the patient's neurological status. It is important to correctly classify the fracture to ensure appropriate treatment. Nerve or spinal cord injuries, pseudarthrosis or malunion, and postoperative infection are the main complications of cervical spine fractures. CONCLUSIONS: Fractures of the cervical spine are potentially serious and devastating if not properly treated. Achieving the correct diagnosis and classification of a lesion is the first step toward identifying the most appropriate treatment, which can be either surgical or conservative.

  17. Fractures of the cervical spine (United States)

    Marcon, Raphael Martus; Cristante, Alexandre Fogaça; Teixeira, William Jacobsen; Narasaki, Douglas Kenji; Oliveira, Reginaldo Perilo; de Barros Filho, Tarcísio Eloy Pessoa


    OBJECTIVES: The aim of this study was to review the literature on cervical spine fractures. METHODS: The literature on the diagnosis, classification, and treatment of lower and upper cervical fractures and dislocations was reviewed. RESULTS: Fractures of the cervical spine may be present in polytraumatized patients and should be suspected in patients complaining of neck pain. These fractures are more common in men approximately 30 years of age and are most often caused by automobile accidents. The cervical spine is divided into the upper cervical spine (occiput-C2) and the lower cervical spine (C3-C7), according to anatomical differences. Fractures in the upper cervical spine include fractures of the occipital condyle and the atlas, atlanto-axial dislocations, fractures of the odontoid process, and hangman's fractures in the C2 segment. These fractures are characterized based on specific classifications. In the lower cervical spine, fractures follow the same pattern as in other segments of the spine; currently, the most widely used classification is the SLIC (Subaxial Injury Classification), which predicts the prognosis of an injury based on morphology, the integrity of the disc-ligamentous complex, and the patient's neurological status. It is important to correctly classify the fracture to ensure appropriate treatment. Nerve or spinal cord injuries, pseudarthrosis or malunion, and postoperative infection are the main complications of cervical spine fractures. CONCLUSIONS: Fractures of the cervical spine are potentially serious and devastating if not properly treated. Achieving the correct diagnosis and classification of a lesion is the first step toward identifying the most appropriate treatment, which can be either surgical or conservative. PMID:24270959

  18. New propant schedule in hydralic fracturing

    Energy Technology Data Exchange (ETDEWEB)

    Wang, H.; Fan, C.


    A new proppant schedule is suggested to obtain maximum propping surface area and maximum fracture conductivity near the borehole. The small and middle size sands are suspended in the fracturing fluids under fracturing condition to prop the total fracture surface area created by fracturing. The coarse sands pumped into fracture later deposit in the fracture at the dynamic width near the borehole during fracturing and reach the equilibrium height in the time interval of pumping coarse sands. Thus, fracture conductivity near the borehole is increased. Computer calculation of the sand program, the corresponding fluid program and pumping rates are presented also.


    Energy Technology Data Exchange (ETDEWEB)

    Abbas Firoozabadi


    The four chapters that are described in this report cover a variety of subjects that not only give insight into the understanding of multiphase flow in fractured porous media, but they provide also major contribution towards the understanding of flow processes with in-situ phase formation. In the following, a summary of all the chapters will be provided. Chapter I addresses issues related to water injection in water-wet fractured porous media. There are two parts in this chapter. Part I covers extensive set of measurements for water injection in water-wet fractured porous media. Both single matrix block and multiple matrix blocks tests are covered. There are two major findings from these experiments: (1) co-current imbibition can be more efficient than counter-current imbibition due to lower residual oil saturation and higher oil mobility, and (2) tight fractured porous media can be more efficient than a permeable porous media when subjected to water injection. These findings are directly related to the type of tests one can perform in the laboratory and to decide on the fate of water injection in fractured reservoirs. Part II of Chapter I presents modeling of water injection in water-wet fractured media by modifying the Buckley-Leverett Theory. A major element of the new model is the multiplication of the transfer flux by the fractured saturation with a power of 1/2. This simple model can account for both co-current and counter-current imbibition and computationally it is very efficient. It can be orders of magnitude faster than a conventional dual-porosity model. Part II also presents the results of water injection tests in very tight rocks of some 0.01 md permeability. Oil recovery from water imbibition tests from such at tight rock can be as high as 25 percent. Chapter II discusses solution gas-drive for cold production from heavy-oil reservoirs. The impetus for this work is the study of new gas phase formation from in-situ process which can be significantly

  20. Pediatric elbow fractures: MRI evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Beltran, J. (Dept. of Radiology, Hospital for Joint Diseases, New York, NY (United States)); Rosenberg, Z.S. (Dept. of Radiology, Hospital for Joint Diseases, New York, NY (United States)); Kawelblum, M. (Dept. of Orthopaedic Surgery, Hospital for Joint Diseases, New York, NY (United States)); Montes, L. (Dept. of Radiology, Beth Israel Medical Center, New York, NY (United States)); Bergman, A.G. (Dept. of Radiology, Stanford Univ., School of Medicine, CA (United States)); Strongwater, A. (Dept. of Orthopaedic Surgery, Hospital for Joint Diseases, New York, NY (United States))


    Magnetic resonance imaging (MRI) was performed in eight patients under the age of 8 years who suffered elbow fractures, to assess possible fracture extension into the distal nonossified epiphysis of the humerus in seven cases and to determine the displacement and location of the radial head in one case. MRI allowed accurate depiction of the fracture line when it extended into the cartilaginous epiphysis. In four cases, MRI findings were confirmed at surgery. In five cases, surgery was obviated because no articular extension of the fracture was seen on MRI (4 cases) or because no displacement was noted (1 case). In one patient, the plain film diagnosis of a Salter type II fracture was changed to Salter type IV on the basis of the MRI findings. It is concluded that MRI might play a role in the preoperative evaluation of pediatric patients presenting with elbow trauma when extension of the fracture cannot be determined with routine radiographic studies. (orig.)

  1. Complex Fluids and Hydraulic Fracturing. (United States)

    Barbati, Alexander C; Desroches, Jean; Robisson, Agathe; McKinley, Gareth H


    Nearly 70 years old, hydraulic fracturing is a core technique for stimulating hydrocarbon production in a majority of oil and gas reservoirs. Complex fluids are implemented in nearly every step of the fracturing process, most significantly to generate and sustain fractures and transport and distribute proppant particles during and following fluid injection. An extremely wide range of complex fluids are used: naturally occurring polysaccharide and synthetic polymer solutions, aqueous physical and chemical gels, organic gels, micellar surfactant solutions, emulsions, and foams. These fluids are loaded over a wide range of concentrations with particles of varying sizes and aspect ratios and are subjected to extreme mechanical and environmental conditions. We describe the settings of hydraulic fracturing (framed by geology), fracturing mechanics and physics, and the critical role that non-Newtonian fluid dynamics and complex fluids play in the hydraulic fracturing process.

  2. [Patella fractures in knee arthroplasty]. (United States)

    Roth, A; Ghanem, M; Fakler, J


    Periprosthetic patella fractures occur both with and without retropatellar joint replacement. A non-operative treatment yields satisfactory results with low morbidity. It can be applied in minimally displaced fractures that have an intact retropatellar component and an intact extensor mechanism, combined with an initial immobilization. The surgical treatment is associated with relatively poor results and with high complication rates. There was only minor improvement of functional results, no matter which surgical technique was used. Surgical intervention is still required in fractures with a loosening of the patellar component, considerable dislocations of fragments, and damage to or rupture of the extensor mechanism. In particular, type II fractures require repair of the extensor mechanism and the fracture or patellectomy. Type III fractures require a revision or resection of the patella, a patelloplasty or total patellectomy. In addition, early or late reconstruction using allograft to restore the extensor mechanism can be taken in consideration.

  3. [Distal humerus fractures in children]. (United States)

    Schneidmueller, D; Boettger, M; Laurer, H; Gutsfeld, P; Bühren, V


    Fractures of the distal humerus belong to the most common injuries of the upper arm in childhood. Most frequently occurring is the supracondylar fracture of the distal humerus. In these cases and in the second most common epicondylar fractures, the metaphysis is affected and these fractures are therefore extra-articular. They have to be distinguished from articular fractures regarding therapy and prognosis. The growth potential of the distal epiphysis is very limited as is the possibility of spontaneous correction so that major dislocations should not be left uncorrected. Unstable and especially dislocated articular fractures must be anatomically reconstructed employing various osteosynthetic techniques, mostly combined with immobilization. Insufficient reconstruction, growth disturbance and non-union can result in axial deformities, such as cubitus valgus and varus, restriction of motion, pain and nerve palsy.

  4. Periprosthetic fractures of the acetabulum. (United States)

    Helfet, David L; Ali, Arif


    Periprosthetic fractures of the acetabulum after total hip arthroplasty are uncommon, but are increasing in number and severity. These fractures may occur intraoperatively, during the perioperative period, or many years after the total hip arthroplasty. Periprosthetic fractures of the acetabulum vary in severity and may involve stress fractures of the pubis or medial wall, significant bone loss secondary to osteolysis and subsequent loss of column integrity, or complete pelvic discontinuity. Treatment differs depending on the complexity of the fracture and the stability of the acetabular prosthesis. Surgical treatment for an unstable acetabulum should stabilize the bony columns of the acetabulum, provide bone grafting of defects, and should maintain adequate bone stock for replacement of a stable acetabular implant. Strict adherence to the principles of fracture surgery is required to achieve bony union of the acetabular columns and provide a stable environment for reimplantation of an acetabular component.

  5. Seismic determination of saturation in fractured reservoirs (United States)

    Brown, R.L.; Wiggins, M.L.; Gupta, A.


    Detecting the saturation of a fractured reservoir using shear waves is possible when the fractures have a geometry that induces a component of movement perpendicular to the fractures. When such geometry is present, vertically traveling shear waves can be used to examine the saturation of the fractured reservoir. Tilted, corrugated, and saw-tooth fracture models are potential examples.

  6. CT examinations of healing fractures

    Energy Technology Data Exchange (ETDEWEB)

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


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

  7. Fracture Phenomena in Amorphous Selenium

    DEFF Research Database (Denmark)

    Lindegaard-Andersen, Asger; Dahle, Birgit


    the velocities of ultrasonic longitudinal and shear waves were measured to 1820 m/sec and 930 m/sec, respectively. Based on these results the two line systems in the transition zone can be interpreted as ``Wallner lines'' with sources within the zone. ©1966 The American Institute of Physics......Fracture surfaces of amorphous selenium broken in flexure at room temperature have been studied. The fracture velocity was found to vary in different regions of the fracture surface. Peculiar features were observed in a transition zone between fast and slower fracture. In this zone cleavage steps...

  8. Posterior bicondylar tibial plateau fractures. (United States)

    Carlson, DuWayne A


    To present a case series of patients with posterior bicondylar tibial plateau fractures treated by direct fracture exposure and fixation through dual incisions. Retrospective clinical study. Level 1 trauma centers. Eight patients were identified that had posterior bicondylar tibial plateau fractures. Two patients had depressed posterolateral tibial plateau fractures with contained defects and did not have direct fracture exposure. One patient died of medical problems leaving 5 patients who underwent direct fracture exposure, reduction, and fixation. Posteromedial followed by posterolateral open reduction and internal fixation of posterior bicondylar tibial plateau fractures. At 6 to 24 months follow-up (mean 13 months), all patients returned to near full activities, each with aching after prolonged standing (8-hour shift). Range of motion averaged 2 degrees to 121 degrees of flexion. Three of 5 returned to manual labor jobs; the others were not employed at the time of injury. Posterior bicondylar tibial plateau fractures have a high association with lateral meniscal pathology and can be associated with anterior cruciate ligament injury. Reduction of the posterior plateau condyles is easiest with the knee in full extension. Flexion contractures can be a problem, and patients should be encouraged to regain/maintain knee extension. The dual-incision approach to these challenging fractures can result in good to excellent knee function for these patients.

  9. Postpartal sacral fracture without osteoporosis. (United States)

    Rousière, M; Kahan, A; Job-Deslandre, C


    Stress fractures of the sacrum during pregnancy or the postpartum seem uncommon. We report a new case of nontrauma-related postpartal sacral fracture. Only four similar cases have been reported to date. The patient was 36 years of age and her fracture was diagnosed four weeks after her first delivery. Vitamin D levels were low, but there was no osteomalacia. Other standard laboratory tests were normal, as were absorptiometry measurements at the lumbar spine and femur. Rheumatologists should consider sacral fracture in pregnant or nursing patients with buttock pain. Magnetic resonance imaging is the diagnostic investigation of choice.

  10. Classification of subtrochanteric femoral fractures. (United States)

    Loizou, C L; McNamara, I; Ahmed, K; Pryor, G A; Parker, M J


    A review of the literature identified 15 different classification methods for subtrochanteric femoral fractures. Only eight of those classifications defined the area of bone, which constituted a subtrochanteric fracture. The actual length of femur defined as the subtrochanteric zone varied from 3 cm up to the level of the femoral isthmus. There was no agreement between the different classifications regarding the proximal and distal border or for those fractures, which traverse anatomical boundaries. In the various classifications, fractures were subdivided into 2-15 subgroups. The majority of the identified studies were unable to find the classifications useful in either determining treatment or predicting the outcome after treatment. We subdivided subtrochanteric fractures into three types based on the degree of fracture comminution. We examined the inter- and intra-observer agreement of our recommended classification. One orthopaedic consultant, one specialist hip fracture surgeon, two trainee registrar orthopaedic surgeons and one specialty trainee in orthopaedics, on two different occasions, 8 weeks apart, independently classified the radiographs of 20 patients with a subtrochanteric fracture. The mean kappa value for inter- and intra-observer variation was 0.71 and 0.79, respectively, with both showing substantial agreement and, therefore, this simpler classification is recommended. Based on the review of previous classification methods, we also recommend that the subtrochanteric zone be defined as the one in which the fracture line crossing the femur is predominantly within the area of bone extending 5 cm below the lower border of the lesser trochanter.

  11. Managing periprosthetic femoral stem fractures. (United States)

    Rosenberg, Aaron G


    Periprosthetic fractures can be difficult to manage. The classification system developed in Vancouver is simple and useful in determining appropriate treatment. It takes into account the site of the fracture, the stability of the implant, and the surrounding bone stock, which are the important elements of the fracture and hip that determines treatment. Understanding this classification system should allow the practitioner to choose the appropriate treatment. In addition to fracture management skills, understanding how to perform a host of hip revision technique may also be required.

  12. Bilateral Mandibular Condylar Fractures with Associated External Auditory Canal Fractures and Otorrhagia


    Dang, David


    A rare case of bilateral mandibular condylar fractures associated with bilateral external auditory canal fractures and otorrhagia is reported. The more severe external auditory canal fracture was present on the side of high condylar fracture, and the less severe external auditory canal fracture was ipsilateral to the condylar neck fracture. A mechanism of injury is proposed to account for such findings.

  13. Bilateral Mandibular Condylar Fractures with Associated External Auditory Canal Fractures and Otorrhagia. (United States)

    Dang, David


    A rare case of bilateral mandibular condylar fractures associated with bilateral external auditory canal fractures and otorrhagia is reported. The more severe external auditory canal fracture was present on the side of high condylar fracture, and the less severe external auditory canal fracture was ipsilateral to the condylar neck fracture. A mechanism of injury is proposed to account for such findings.

  14. Fracture network growth for prediction of fracture characteristics and connectivity in tight reservoir rocks

    NARCIS (Netherlands)

    Barnhoorn, A.; Cox, S.F.


    Fracturing experiments on very low-porosity dolomite rocks shows a difference in growth of fracture networks by stress-driven fracturing and fluid-driven fracturing. Stress-driven fracture growth, in the absence of fluid pressure, initially forms fractures randomly throughout the rocks followed by g

  15. Fracture Rates and Fracture Sites in Patients With Osteogenesis Imperfecta

    DEFF Research Database (Denmark)

    Folkestad, Lars; Hald, Jannie Dahl; Ersbøll, Annette Kjaer;


    , with a peak during the toddler and adolescent years (incidence rate [IR] 233.9 per 1000 person years), fewer fractures during adulthood (IR 84.5 per 1000 person years), and increased fracture rates in older women (IR 111.9 per 1000 person years). This is the largest register-based nationwide study...... years. In comparison, 709 persons in the reference population experienced a total of 1018 fractures during follow-up. Both male and female patients with OI had an increased fracture rate throughout their life. The fracture rate ratio for participants aged 0 to 19 years was 10.7, for participants aged 20...... to 54 years 17.2, and for participants aged 55 years and over 4.1 when compared to the reference population. The highest fracture rate was seen in males with OI aged 0 to 19 years (257 fractures per 1000 person-years). The fractures appear to follow the same pattern as in the general population...

  16. Modelling of Specimen Fracture (United States)


    the plate center. An end load of 1.0 MPa was applied. 1 2 3 Modelling of Specimen Fracture – Final Report 11 TR-13-47 Figure 2.5: Crack Geometry Figure...Christopher Bayley DRDC Atlantic Dockyard Laboratory Pacific CFB Esquimalt, Building 199 PO Box 17000, Station Forces Victoria, British Columbia Canada...q The weighting function, q , can be any arbitrary function within the J-integral domain, and must be zero on the domain boundary . An easy function

  17. Image diagnosis of nasal bone fracture

    Energy Technology Data Exchange (ETDEWEB)

    Hirota, Yoshiharu; Shimizu, Yayoi; Iinuma, Toshitaka.


    Twenty cases of nasal bone fractures were evaluated as to the types of fractures based upon HRCT findings. Conventional X-Ray films for nasal bones were analyzed and compared with HRCT findings. Nasal bone fractures were classified into lateral and frontal fractures. HRCT images were evaluated in three planes including upper, middle and lower portions of the nasal bone. Fractures favored males of teens. Lateral fracture gave rise to the fractures of the nasal bone opposite to the external force, loosening of the ipsilateral nasomaxillary sutures and fractures of the frontal process of the maxilla. Conventional X-Ray films were reevaluated after HRCT evaluation and indications of nasal bone fractures were determined. In addition to the discontinuity of the nasal dorsum, fracture lines parallel to and beneath the nasal dorsum and indistinct fracture lines along the nasomaxillary sutures are the indication of nasal bone fractures by conventional X-Ray films.

  18. Gravity-Driven Hydraulic Fractures (United States)

    Germanovich, L. N.; Garagash, D.; Murdoch, L. C.; Robinowitz, M.


    This study is motived by a new method for disposing of nuclear waste by injecting it as a dense slurry into a hydraulic fracture that grows downward to great enough depth to permanently isolate the waste. Disposing of nuclear waste using gravity-driven hydraulic fractures is mechanically similar to the upward growth of dikes filled with low density magma. A fundamental question in both applications is how the injected fluid controls the propagation dynamics and fracture geometry (depth and breadth) in three dimensions. Analog experiments in gelatin [e.g., Heimpel and Olson, 1994; Taisne and Tait, 2009] show that fracture breadth (the short horizontal dimension) remains nearly stationary when the process in the fracture "head" (where breadth is controlled) is dominated by solid toughness, whereas viscous fluid dissipation is dominant in the fracture tail. We model propagation of the resulting gravity-driven (buoyant or sinking), finger-like fracture of stationary breadth with slowly varying opening along the crack length. The elastic response to fluid loading in a horizontal cross-section is local and can be treated similar to the classical Perkins-Kern-Nordgren (PKN) model of hydraulic fracturing. The propagation condition for a finger-like crack is based on balancing the global energy release rate due to a unit crack extension with the rock fracture toughness. It allows us to relate the net fluid pressure at the tip to the fracture breadth and rock toughness. Unlike the PKN fracture, where breadth is known a priori, the final breadth of a finger-like fracture is a result of processes in the fracture head. Because the head is much more open than the tail, viscous pressure drop in the head can be neglected leading to a 3D analog of Weertman's hydrostatic pulse. This requires relaxing the local elasticity assumption of the PKN model in the fracture head. As a result, we resolve the breadth, and then match the viscosity-dominated tail with the 3-D, toughness

  19. Zoledronic acid and clinical fractures and mortality after hip fracture

    DEFF Research Database (Denmark)

    Lyles, Kenneth W; Colón-Emeric, Cathleen S; Magaziner, Jay S


    BACKGROUND: Mortality is increased after a hip fracture, and strategies that improve outcomes are needed. METHODS: In this randomized, double-blind, placebo-controlled trial, 1065 patients were assigned to receive yearly intravenous zoledronic acid (at a dose of 5 mg), and 1062 patients were...... assigned to receive placebo. The infusions were first administered within 90 days after surgical repair of a hip fracture. All patients (mean age, 74.5 years) received supplemental vitamin D and calcium. The median follow-up was 1.9 years. The primary end point was a new clinical fracture. RESULTS...... in the two groups. CONCLUSIONS: An annual infusion of zoledronic acid within 90 days after repair of a low-trauma hip fracture was associated with a reduction in the rate of new clinical fractures and with improved survival. ( number, NCT00046254 [].)....

  20. Functional outcome after Mason II-III radial head and neck fractures: study protocol for a systematic review in accordance with the PRISMA statement. (United States)

    Hagelberg, Mårten; Thune, Alexandra; Krupic, Ferid; Salomonsson, Björn; Sköldenberg, Olof


    Fractures of the radial head and neck are the most common fractures of the elbow, and account for approximately one-third of all elbow fractures. Depending on the fracture type the treatment is either conservative or surgical. There is no absolute consensus regarding optimal treatment for different fracture types. The aim of this protocol is to present the method that will be used to collect, describe and analyse the current evidence regarding the treatment of Mason II-III radial head and neck fractures. We will conduct a systematic review in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P) guidelines statement. We will search a number of databases with a predefined search strategy to collect both randomised and non-randomised studies. The articles will be summarised with descriptive statistics. If applicable a meta-analysis will be conducted. Ethical approval is not required since this is a protocol for a systematic review and no primary data will be collected. The authors will publish findings from this review in a peer-reviewed scientific journal. CRD42016037627. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  1. Fracture Detection and Mapping

    Energy Technology Data Exchange (ETDEWEB)

    Goldstein, Norman E.; Iovenitti, Joseph L.


    Because the costs of drilling, completing, and testing a well can be extremely high, it is important to develop better tools and methods for locating high permeability zones prior to drilling, and to develop better tools and methods for identifying and characterizing major fracture zones during the drilling and well testing stages. At the recommendation of the LBL Industry Review Panel on Geothermal Reservoir Technology, we organized and convened a one-day workshop this past July to discuss various aspects of DOE's current and planned activities in fracture detection, to review the geothermal industry's near-term and long-term research needs, to determine the priority of those needs, to disseminate to industry the status of research in progress, and to discuss the possibility of future joint research between industry and DOE. In this paper we present a brief overview of the workshop from the perspective of those who participated in it and provided us with written comments to a questionnaire that was distributed.

  2. Fracture detection and mapping

    Energy Technology Data Exchange (ETDEWEB)

    Goldstein, N.E.; Iovenitti, J.L.


    Because the costs of drilling, completing, and testing a well can be extremely high, it is important to develop better tools and methods for locating high permeability zones prior to drilling, and to develop better tools and methods for identifying and characterizing major fracture zones during the drilling and well testing stages. At the recommendation of the LBL Industry Review Panel on Geothermal Reservoir Technology, we organized and convened a one-day workshop this past July to discuss various aspects of DOE's current and planned activities in fracture detection, to review the geothermal industry's near-term and long-term research needs, to determine the priority of those needs, to disseminate to industry the status of research in progress, and to discuss the possibility of future joint research between industry and DOE. In this paper we present a brief overview of the workshop from the perspective of those who participated in it and provided us with written comments to a questionnaire that was distributed.

  3. Diplopia and orbital wall fractures

    NARCIS (Netherlands)

    Boffano, P.; Roccia, F.; Gallesio, C.; Karagozoglu, K.H.; Forouzanfar, T.


    Diplopia is a symptom that is frequently associated with orbital wall fractures. The aim of this article was to present the incidence and patterns of diplopia after orbital wall blow-out fractures in 2 European centers, Turin and Amsterdam, and to identify any correlation between this symptom and su

  4. Cough-induced rib fractures. (United States)

    Sano, Atsushi; Tashiro, Ken; Fukuda, Tsutomu


    Occasionally, patients who complain of chest pain after the onset of coughing are diagnosed with rib fractures. We investigated the characteristics of cough-induced rib fractures. Between April 2008 and December 2013, 17 patients were referred to our hospital with chest pain after the onset of coughing. Rib radiography was performed, focusing on the location of the chest pain. When the patient had other signs and symptoms such as fever or persistent cough, computed tomography of the chest was carried out. We analyzed the data retrospectively. Rib fractures were found in 14 of the 17 patients. The age of the patients ranged from 14 to 86 years (median 39.5 years). Ten patients were female and 4 were male. Three patients had chronic lung disease. There was a single rib fracture in 9 patients, and 5 had two or more fractures. The middle and lower ribs were the most commonly involved; the 10th rib was fractured most frequently. Cough-induced rib fractures occur in every age group regardless of the presence or absence of underlying disease. Since rib fractures often occur in the lower and middle ribs, rib radiography is useful for diagnosis. © The Author(s) 2015.

  5. Bilateral acetabular fracture without trauma


    De Rosa, M. A.; G. Maccauro; D’Arienzo, M.


     In the absence of trauma fracture of the acetabulum is an extremely rare injury. We describe a 70 year old man who spontaneously developed fractures in both acetabulae due to bony insufficiency. It was successfully treated by bilateral total hip replacement.

  6. Epidemiological study on talus fractures

    Directory of Open Access Journals (Sweden)

    Marcos Hideyo Sakaki


    Full Text Available Objective:To analyze the characteristics of patients with talus fractures and the injuries that they present.Methods:Retrospective analysis on patients hospitalized in the Institute of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine of the University of São Paulo, between 2006 and 2011, with talus fractures. Patient profile parameters, risk factors, fracture characteristics, treatment data and acute complications were analyzed.Results:Analysis on 23 cases showed that men were more affected than women, with a ratio of 4.8:1. The most frequent trauma mechanism was traffic accidents, followed by falls from a height. The most frequent type of fracture was at the neck of the talus, with 17 cases. Among the 23 cases, seven had peritalar dislocation at the time of presentation, four had exposed fractures and 11 presented other associated fractures. The mean length of time between the trauma and the definitive treatment was six days, while the mean length of hospital stay was 11 days. Three patients presented acute postoperative complications.Conclusion:Talus fractures occurred most commonly in the region of the talar neck and most frequently in young males who suffered high-energy trauma. In almost half of the cases, there were other associated fractures. The length of hospital stay was 11 days.

  7. Polymer liquids fracture like solids

    DEFF Research Database (Denmark)

    Huang, Qian; Hassager, Ole


    While fracture in brittle solids has been studied for centuries until today, there are few studies on fracture in polymer liquids. Recent developments in experimental techniques, especially the combination of controlled filament stretching rheometry and high speed imaging, have opened new windows...

  8. Global Trends in Maxillofacial Fractures


    Lee, Kai


    Background The etiology, demographics, fracture site in facial injury patients have been reported worldwide. However, few studies have attempted to identify changes in maxillofacial fractures over time periods and between countries. The statistics are vastly different due to variations in social, environmental, and cultural factors.

  9. Excess mortality following hip fracture

    DEFF Research Database (Denmark)

    Abrahamsen, B; van Staa, T; Ariely, R;


    Summary This systematic literature review has shown that patients experiencing hip fracture after low-impact trauma are at considerable excess risk for death compared with nonhip fracture/community control populations. The increased mortality risk may persist for several years thereafter, highlig...

  10. Diplopia and orbital wall fractures

    NARCIS (Netherlands)

    Boffano, P.; Roccia, F.; Gallesio, C.; Karagozoglu, K.H.; Forouzanfar, T.


    Diplopia is a symptom that is frequently associated with orbital wall fractures. The aim of this article was to present the incidence and patterns of diplopia after orbital wall blow-out fractures in 2 European centers, Turin and Amsterdam, and to identify any correlation between this symptom and

  11. Fracture mechanics in pavement design

    CSIR Research Space (South Africa)

    Denneman, E


    Full Text Available effects. Examples of the use of fracture mechanics providing an alternative to these conventional design parameters are given in the paper. The paper shows that although much further development is required before fracture mechanics can be relied upon...

  12. Hydraulic fracturing with chlorine dioxide cleanup

    Energy Technology Data Exchange (ETDEWEB)

    Williams, D.A.; Newlove, J.C.; Horton, R.L.


    This patent describes a method for fracturing a subterranean formation penetrated by a wellbore. It comprises: injecting a fracturing fluid into the formation to form a vertical fracture therein, the fracturing fluid being gelled with a polymer selected from guar, guar derivatives, acrylamide, acrylamide derivatives, cellulose, cellulose derivatives, and mixtures thereof and crosslinked with an organometallic crosslinking compound and having temperature stability above about 175{degrees} F.; packing the fracture with particulate propping agent; backflowing fluids from the formation through the propped fracture to remove a portion of the polymer; injecting at matrix rates sufficient aqueous solution of chlorine dioxide down the wellbore and into the propped fracture to penetrate at least 60 feet of the propped fracture length and contact polymer in the fracturing fluid and polymer residue in the propped fracture and on the fracture walls, the amount of the chlorine dioxide in the aqueous medium being sufficient to degrade polymer in the fracturing fluid and polymer residue; permitting the chlorine dioxide to remain in contact with the polymer in the fracturing fluid and with the polymer residue on the fracture walls and in the fracture for sufficient time to degrade the polymer thereby reducing the fracturing fluid viscosity and dissolving portions of the polymer residue; and flowing formation fluid from the formation through the propped fracture and into the wellbore to remove substantial portions of the polymer and degraded polymer from the fracture.

  13. Isolated Transverse Sacrum Fracture: A Case Report

    Directory of Open Access Journals (Sweden)

    Cemil Kavalci


    Full Text Available Sacral fracture commonly results from high-energy trauma. Most insufficiency fractures of the sacrum are seen in women after the age of 70. Fractures of the sacrum are rare and generally combined with a concomitant pelvic fracture. Transverse sacral fractures are even less frequent which constitute only 3–5% of all sacral fractures. This type of fractures provide a diagnostic challenge. We report a unique case of isolated transverse fracture of sacrum in a young man sustained low-energy trauma. The patient presented to our emergency department after several hours of injury, and diagnosed by clinical features and roentgenogram findings.

  14. Distal clavicle fractures in children☆ (United States)

    Labronici, Pedro José; da Silva, Ricardo Rodrigues; Franco, Marcos Vinícius Viana; Labronici, Gustavo José; Pires, Robinson Esteves Santos; Franco, José Sergio


    Objective To analyze fractures of the distal clavicle region in pediatric patients. Methods Ten patients between the ages of five to eleven years (mean of 7.3 years) were observed. Nine patients were treated conservatively and one surgically. All the fractures were classified using the Nenopoulos classification system. Results All the fractures consolidated without complications. Conservative treatment was used for nine patients, of whom three were in group IIIB, three IIb, two IIa and one IV. The only patient who was treated surgically was a female patient of eleven years of age with a group IV fracture. Conclusion The treatment indication for distal fractures of the clavicle in children should be based on the patient's age and the displacement of the fragments. PMID:26962489

  15. Pathogenesis of osteoporotic hip fractures. (United States)

    McClung, Michael R


    Osteoporosis is characterized late in the course of the disease by an increased risk of fracture, particularly in the elderly. It occurs in both sexes, affecting approximately 8 million women and 2 million men aged > or = 50 years (1). While low bone density is a predictor of fractures, it is not the only determinant of fracture risk. Other factors include advanced age, altered bone quality, a personal or family history of falls, frailty, poor eyesight, debilitating diseases, and high bone turnover. A diet with sufficient calcium and vitamin D is important to minimize bone loss and, along with regular exercise, to maintain muscle strength. Bisphosphonates have been shown to reduce the risk of hip fracture. For elderly patients, the use of hip protectors may be used as a treatment of last resort. Regardless of the age of the patient, individual patient risk factors must be considered to target appropriate treatment and prevent fracture.

  16. Fractures of the proximal humerus

    DEFF Research Database (Denmark)

    Brorson, Stig


    Fractures of the proximal humerus have been diagnosed and managed since the earliest known surgical texts. For more than four millennia the preferred treatment was forceful traction, closed reduction, and immobilization with linen soaked in combinations of oil, honey, alum, wine, or cerate....... The bandages were further supported by splints made of wood or coarse grass. Healing was expected in forty days. Different fracture patterns have been discussed and classified since Ancient Greece. Current classification of proximal humeral fractures mainly relies on the classifications proposed by Charles......, classification of proximal humeral fractures remains a challenge for the conduct, reporting, and interpretation of clinical trials. The evidence for the benefits of surgery in complex fractures of the proximal humerus is weak. In three systematic reviews I studied the outcome after locking plate osteosynthesis...

  17. Distal clavicle fractures in children

    Directory of Open Access Journals (Sweden)

    Pedro José Labronici


    Full Text Available ABSTRACT OBJECTIVE: To analyze fractures of the distal clavicle region in pediatric patients. METHODS: Ten patients between the ages of five to eleven years (mean of 7.3 years were observed. Nine patients were treated conservatively and one surgically. All the fractures were classified using the Nenopoulos classification system. RESULTS: All the fractures consolidated without complications. Conservative treatment was used for nine patients, of whom three were in group IIIB, three IIb, two IIa and one IV. The only patient who was treated surgically was a female patient of eleven years of age with a group IV fracture. CONCLUSION: The treatment indication for distal fractures of the clavicle in children should be based on the patient's age and the displacement of the fragments.

  18. Physical chemistry of glass fracture

    Energy Technology Data Exchange (ETDEWEB)

    Michalske, T.A. [Sandia National Laboratories, Albuquerque, NM (United States)


    Since silica glass is a brittle material, its susceptibility to fracture often limits its use in technological applications. Previous studies have demonstrated that the fracture resistance of silica glass is decreased greatly by the presence of chemically reactive species such as water. By studying the effect of controlled amounts of reactive gases on the fracture rate in silica glass, the authors have developed chemical kinetics based models to describe the molecular level processes that lead to stress corrosion fracture of glass. A key aspect of our chemical kinetics based model is the measurement of the stress dependence for the hydrolysis of siloxane bonds. The authors derive the stress dependence for hydrolysis from reaction rate studies that are conducted on strained cyclosiloxane model compounds. The chemical kinetic parameter derived from model compounds is used to successfully predict the fracture behavior of bulk silica glass and the mechanical fatigue of high-strength silica glass fibers in various reactive chemical environments.

  19. Numerical Analysis on the Formation of Fracture Network during the Hydraulic Fracturing of Shale with Pre-Existing Fractures

    Directory of Open Access Journals (Sweden)

    Jianming He


    Full Text Available In this paper, configurations of pre-existing fractures in cubic rock blocks were investigated and reconstructed for the modeling of experimental hydraulic fracturing. The fluid-rock coupling process of hydraulic fracturing was simulated based on the displacement discontinuities method. The numerical model was validated against the related laboratory experiments. The stimulated fracture configurations under different conditions can be clearly shown using the validated numerical model. First, a dominated fracture along the maximum principle stress direction is always formed when the stress difference is large enough. Second, there are less reopened pre-existing fractures, more newly formed fractures and less shear fractures with the increase of the cohesion value of pre-existing fractures. Third, the length of the stimulated shear fracture decreases rapidly with the increase of the friction coefficient, while the length of the tensile fracture has no correlation to the fiction coefficient. Finally, the increase of the fluid injection rate is favorable to the formation of a fracture network. The unfavorable effects of the large stress difference and the large cohesion of pre-existing fractures can be partly suppressed by an increase of the injection rate in the hydraulic fracturing treatment. The results of this paper are useful for understanding fracture propagation behaviors during the hydraulic fracturing of shale reservoirs with pre-existing fractures.

  20. Avulsion-fracture of the anterior superior iliac spine with meralgia paresthetica: a case report. (United States)

    Hayashi, Shinya; Nishiyama, Takayuki; Fujishiro, Takaaki; Kanzaki, Noriyuki; Kurosaka, Masahiro


    We present a rare case of avulsion-fracture of the anterior superior iliac spine with meralgia paresthetica in a 16-year-old male basketball player. He had sensory disturbance affecting his left lateral thigh 10 days after the injury. Tinel's sign was elicited on percussing the avulsed bony fragment of the anterior superior iliac spine. He underwent open reduction and internal fixation. The lateral femoral cutaneous nerve was noted to be entrapped by one third of the avulsed bony fragment. That fragment was removed, and the remaining portion was reduced and fixed with 2 screws. At week 6, the patient had returned to basketball playing without pain. At week 8, sensory distribution in the left lateral thigh had returned to normal.

  1. Complex multilevel lumbar spine fractures with transverse sacral fracture

    Directory of Open Access Journals (Sweden)

    Kshitij Chaudhary


    Full Text Available We report an unusual and complex case of spinal trauma in a 17-year-old boy who presented with a transverse sacral fracture associated with multiple-level lumbar fractures, paraparesis, and bladder involvement. A two-stage surgery was performed. The lumbar spine fractures were treated with posterior instrumented correction of displacements, followed by anterior instrumentation and fusion. The sacral fracture was left untreated. At 5-year followup, the patient had complete neurological recovery except for the right L5 root function. The long-segment lumbar fusion and the untreated displaced sacral fracture contributed to spinal imbalance, due to which the patient is now able to stand only in a crouched posture. Determining the optimal treatment for the case is presented due to the relative rarity of transverse sacral fracture and paucity of evidence-based treatment approaches. In patients with associated lumbar spine fractures that require extension of instrumentation to the upper lumbar spine, it is critical to restore sacropelvic alignment to achieve spinal balance. Adequate reduction of sacropelvic anatomy can be achieved with iliac screw fixation.

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

    Directory of Open Access Journals (Sweden)

    Gultekin Gulbahar


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

  3. Induced seismicity caused by hydraulic fracturing in deep geothermal wells in Germany and adjacent areas (United States)

    Plenefisch, Thomas; Brückner, Lisa; Ceranna, Lars; Gestermann, Nicolai; Houben, Georg; Tischner, Torsten; Wegler, Ulrich; Wellbrink, Matthias; Bönnemann, Christian; Bertram, Andreas; Kirschbaum, Bernd


    Recently, the BGR has worked out a study on the potential environmental impact caused by hydraulic fracturing or chemical stimulations in deep geothermal reservoirs in Germany and adjacent areas. The investigations and analyses are based on existing studies and information provided by operators. The two environmental impacts being essentially considered in the report are induced seismicity and possible contamination of the groundwater reservoirs which serve for drinking water supply. Altogether, in this study, information on 30 hydraulic frac operations and 26 chemical stimulations including information from neighboring countries were compiled and analyzed. Out of the hydraulic stimulations two thirds were carried out as waterfracs and one third as fracturing with proppants. Parameters used in the study to characterize the induced seismicity are maximum magnitude, number of seismic events, size of the seismically active volume, and the relation of this volume to fault zones and the cap rock, as well as, finally, the impacts at the Earth's surface. The response of the subsurface to hydraulic fracturing is variable: There are some activities, which cause perceptible seismic events, others, where no perceptible but instrumentally detected events occurred, and moreover activities without even any instrumentally detected events. A classification of seismic hazard with respect to tectonic region, geology, or depth of the layer is still difficult, since the number of hydraulic fracturing measures in deep geothermal wells is small making a statistically sound analysis impossible. However, there are some indications, that hydraulic fracturing in granite in tectonically active regions like the Upper Rhine Graben results in comparatively stronger, perceptible seismicity compared to hydraulic fracturing in the sedimentary rocks of the North German basin. The maximum magnitudes of induced earthquakes caused by hydraulic fracturing of deep geothermal wells in Germany are

  4. Definition, classification and treatment of destructive fractures

    Directory of Open Access Journals (Sweden)

    FANG Guo-jun


    Full Text Available 【Abstract】 Destructive injury is defined as a very serious damage both to the bone and the soft tissues. But in clinical practice we found that in some fracture cases, the damage to soft tissues is not as severe as 揹estructive injury?indicates, whereas comminuted fractures still cannot show the severity of bone damage. Therefore we proposed a new term 揹estructive fractures?after combining the definition of destructive injury with typical clinic cases. Destructive fractures refer to the fractures whose osseous tissues are damaged too seriously to be repaired, but soft tissues, nerves and veins are less severely injured and can be repaired. From the year 2001 to 2010, 75 cases of destructive fractures were admitted in our department. According to whether the fractures interlinked with the external environment, together with the fracture sites, they were divided into 6 types: a1 type, closed diaphysis destructive fracture; a2 type, open diaphysis destructive fracture; b1 type, closed joint-involved destructive fracture; b2 type, open joint-involved destructive fracture; c1 type, closed mixed destructive fracture; c2 type, open mixed destructive fracture. Corresponding clinical treatments were conducted for each type.The new classification criterion of destructive fracture is simple and practical and thus can be used as an important guide to make reasonable treatment plans for destructive fractures. Key words: Fracture, bone; Classification; Therapeutics

  5. Mechanisms of intergranular fracture

    Energy Technology Data Exchange (ETDEWEB)

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


    The authors present a study of the atomistic mechanisms of crack propagation along grain boundaries in metals and alloys. The failure behavior showing cleavage crack growth and/or crack-tip dislocation emission is demonstrated using atomistic simulations for an embedded-atom model. The simulations follow the quasi-equilibrium growth of a crack as the stress intensity applied increases. Dislocations emitted from crack tips normally blunt the crack and inhibit cleavage, inducing ductile behavior. When the emitted dislocations stay near the crack tip (sessile dislocations), they do blunt the crack but brittle cleavage can occur after the emission of a sufficient number of dislocations. The fracture process occurs as a combination of dislocation emission/micro-cleavage portions that are controlled by the local atomistic structure of the grain boundary. The grain boundary is shown to be a region where dislocation emission is easier, a mechanism that competes with the lower cohesive strength of the boundary region.

  6. [Angle-fixed plate fixation or double-plate osteosynthesis in fractures of the proximal humerus: a biomechanical study]. (United States)

    Hessmann, Martin H; Korner, Jan; Hofmann, Alexander; Sternstein, Werner; Rommens, Pol M


    Internal fixation of fractures of the proximal humerus needs a high stability of fixation to avoid secondary loss of fixation. This is especially important in osteoporotic bone. In an experimental study, the biomechanical properties of the angle-fixed Philos plate (internal fixator) and a double-plate osteosynthesis using two one-third tubular plates were assessed. The fracture model was an unstable three-part fracture (AO type B2). Eight pairs of human cadaveric humeri were submitted to axial load and torque. In the first part of the study, it was assessed to which degree the original stiffness of the humeri could be restored after the osteotomy by the osteosynthesis procedure. Subsequently, subsidence during 200 cycles of axial loading and torque was analysed. During axial loading, the Philos plate was significantly stiffer and showed less irreversible deformation. Two double-plate fixations, but none of the Philos plate osteosynthesis, failed. During torsion, there were no significant differences between the two implants. From the biomechanical point of view, the angle-fixed Philos plate represents the implant of choice for the surgical fixation of highly unstable three-part fractures of the proximal humerus, as the internal fixator system is characterised by superior biomechanical properties.

  7. Early history of scapular fractures. (United States)

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


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

  8. Spontaneous bilateral fracture of patella. (United States)

    Moretti, Biagio; Speciale, Domenico; Garofalo, Raffaele; Moretti, Lorenzo; Patella, Silvio; Patella, Vittorio


    Bilateral patellae fractures represent a rare entity, accounting for approximately 2.9% of all lesions interesting in this anatomical district. In most cases found in the published work, they are described as stress fractures or as complications of chronic diseases such as osteoporosis, renal failure and secondary hyperparathyroidism. Although many pathogenetic mechanisms have been supposed, none have been proved for certain. Insufficiency fractures of the patellae are rare events and no data has been published on their incidence. We present a case of bilateral fracture of the patellae due to an indirect trauma occurring in an 85-year-old patient affected by Parkinson's disease, osteoporosis and diffuse degenerative osteoarthritis. X-ray of the knees (anteroposterior and lateral) and magnetic resonance imaging evaluation confirmed the fractures. The patient was treated conservatively. She had a good result, returning to her previous autonomous ambulation. This case is unusual because there was no direct trauma to the knees because of bilaterality, but confirmed previous observations about insufficiency fractures of patellae in the presence of comorbidity. Insufficiency fractures of patellae can be an insidious condition in elderly people. Prepatellar pain, a common symptom in the relapse phase of degenerative arthritis of the knee, should not be underestimated, particularly in patients with diseases influencing metabolism of bone and with an elevated risk of fall. A periodical clinical and instrumental follow up should be done in these patient. Moreover, we underline the necessity of a multidisciplinary approach.

  9. [Fractures of the humerus head]. (United States)

    Jaeger, M; Izadpanah, K; Maier, D; Reising, K; Strohm, P C; Südkamp, N P


    Fractures of the proximal humerus are commonly seen especially in the elderly population. High-energy trauma in young people can be distinguished from low-energy trauma in the elderly resulting from falls of a low height which are typically characterized by osteoporosis. A precise analysis of fractures is essential for a good understanding of the fracture and an individual therapy for which the LEGO-Codman classification provided by Hertel is recommended. Nonsurgical therapy is commonly performed and widely accepted not only for simple fractures. For osteosynthesis angular stable implants became the gold standard but are frequently associated with a high rate of complications some of which can be lowered by an improved surgical technique. Even today varus dislocated fractures are challenging, especially in combination with destruction of the medial column. In those cases where stable osteosynthesis can no longer be achieved arthroplasty is indicated. The clinical results of anatomic fracture arthroplasty are strongly related with correct ingrowth of the tuberosities. Reverse fracture arthroplasty may be considered but indications should be interpreted with caution and preferably used in patients older than 75 years.

  10. Scapular fractures and concomitant injuries

    Directory of Open Access Journals (Sweden)

    Akaraborworn Osaree


    Full Text Available 【Abstract】 Objective: The association of scapular fractures with other life-threatening injuries including blunt thoracic aortic injury is widely recognized. Few studies have investigated this presumed association. In this study, we investigated the incidence of significant associated injuries with scapular fracture and their outcomes. Methods: A retrospective study was conducted from 2005 to 2009 in a level I trauma center in Thailand. All blunt trauma patients were identified. Patients’ demographics, injury mechanism, associated injuries, Injury Severity Score (ISS, and survival outcomes were recorded. The manage-ment of associated injuries with scapular fracture was reviewed, and the risk factors for mortality were identified. Results: Among the 7 345 trauma patients admitted, scapular fractures occurred in 84 cases (1.1%. The mean age was (37.98±15.21 years. Motorcycle crash was the most fre-quent mechanism of injury, occurring in 51 cases (60.7%. Seventy-four patients (88.1% suffering from scapular frac-tures had associated injuries: 5 (6.0% had significant chest injuries, but none of them had blunt thoracic aortic injury. Two patients (2.4% with scapular fractures died. Factors determining the likelihood of mortality were: (1 ISS>25 (LR=8.5, P<0.05; (2 significant associated chest injury (AIS>3, LR=5.3, P<0.05 and (3 significant associated ab-dominal injury (AIS>3, LR=5.3, P<0.05. Conclusion: A blunt scapular fracture may not accom-pany a blunt thoracic aortic injury but it is strongly related to other injuries like chest injury, extremity injury, head injury, etc. If a scapular fracture is found with a high ISS score, high chest or abdomen AIS score, the patient would have a high risk of mortality. Key words: Aortic rupture; Shoulder fractures; Mul-tiple trauma; Mortality

  11. Possible factors for ankle fractures

    Directory of Open Access Journals (Sweden)

    Tabaković Dejan


    Full Text Available Background/Aim. Classification of ankle fractures is commonly used for selecting an appropriate treatment and prognosing an outcome of definite management. One of the most used classifications is the Danis-Weber classification. To the best of our knowledge, in the available literature, there are no parameters affecting specific types of ankle fractures according to the Danis-Weber classification. The aim of this study was to analyze the correlation of the following parameters: age, body weight, body mass index (BMI, height, osteoporosis, osteopenia and physical exercises with specific types of ankle fractures using the Danis-Weber classification. Methods. A total of 85 patients grouped by the Danis-Weber classification fracture types were analyzed and the significance of certain parameters for specific types of ankle fractures was established. Results. The proportion of females was significantly higher (p < 0.001 with a significantly higher age (59.9 years, SD ± 14.2 in relation to males (45.1 years, SD ± 12.8 (p < 0.0001. Type A fracture was most frequent in the younger patients (34.2 years, SD ± 8.6, and those with increased physical exercises (p = 0.020. In type B fracture, the risk factor was osteoporosis (p = 0.0180, while in type C fracture, body weight (p = 0.017 and osteoporosis (p = 0.004 were significant parameters. Conclusion. Statistical analysis using the Danis-Weber classification reveals that there are certain parameters suggesting significant risk factors for specific types of ankle fractures.

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

    Directory of Open Access Journals (Sweden)

    Ramji Lal Sahu


    Conclusions: The results of the present study indicates that in the presence of proper indications, reamed antegrade intramedullary interlocked nailing appears to be a method of choice for internal fixation of osteoporotic and pathologic fractures.

  13. Operative strategy of acetabular fractures

    Institute of Scientific and Technical Information of China (English)

    WANG Yan; TANG Pei-fu; HUANG Peng


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

  14. Insufficiency fracture after radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Dong Ryul; Huh, Seung Jae [Dept.of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)


    Insufficiency fracture occurs when normal or physiological stress applied to weakened bone with demineralization and decreased elastic resistance. Recently, many studies reported the development of IF after radiation therapy (RT) in gynecological cancer, prostate cancer, anal cancer and rectal cancer. The RT-induced insufficiency fracture is a common complication during the follow-up using modern imaging studies. The clinical suspicion and knowledge the characteristic imaging patterns of insufficiency fracture is essential to differentiate it from metastatic bone lesions, because it sometimes cause severe pain, and it may be confused with bone metastasis.

  15. Treatment of Unstable Ankle Fractures

    Directory of Open Access Journals (Sweden)

    Yaniel Truffín Rodríguez


    Full Text Available Patients with unstable ankle fractures frequently attend the emergency rooms. It is estimated that there are 122 ankle fractures per 100 000 people a year. Surgical treatment of those that are unstable is inevitable since they can not be corrected in a conservative way. Several surgical procedures for repair of such lesions have been described and all of them constitute important tools for the orthopedic surgeon. Therefore, we conducted a literature review to discuss the current management of unstable ankle fractures based on the analysis of the published literature and the experiences in the Dr. Gustavo Aldereguía Lima University General Hospital of Cienfuegos.

  16. Sternal fractures and their management

    Directory of Open Access Journals (Sweden)

    Al-achraf Khoriati


    Full Text Available Sternal fractures are predominantly associated with deceleration injuries and blunt anterior chest trauma. Sternal trauma must be carefully evaluated by monitoring of vital parameters and it is of paramount importance that concomitant injuries are excluded. Nevertheless, routine admission of patients with isolated sternal fractures for observation is still common in today′s practice, which is often unnecessary. This article aims to describe the prognosis, the recommended assessment and management of patients with sternal fractures, to help clinicians make an evidence-based judgment regarding the need for hospitalization.

  17. Prediction of Ductile Fracture Surface Roughness Scaling

    DEFF Research Database (Denmark)

    Needleman, Alan; Tvergaard, Viggo; Bouchaud, Elisabeth


    Experimental observations have shown that the roughness of fracture surfaces exhibit certain characteristic scaling properties. Here, calculations are carried out to explore the extent to which a ductile damage/fracture constitutive relation can be used to model fracture surface roughness scaling....... The scaling properties of the predicted thickness average fracture surfaces are calculated and the results are discussed in light of experimental observations....

  18. Atypical fractures on long term bisphosphonates therapy.

    LENUS (Irish Health Repository)

    Hussein, W


    Bisphosphonates reduce fractures risk in patients with osteoporosis. A new pattern of fractures is now being noted in patients on prolonged bisphosphonate therapy. We report a case of an atypical femoral fracture with preceding pain and highlight the characteristics of these fractures.

  19. Routine functional assessment for hip fracture patients

    DEFF Research Database (Denmark)

    Pedersen, Tonny J; Lauritsen, Jens M


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

  20. Transverse posterior element fractures associated with torsion

    Energy Technology Data Exchange (ETDEWEB)

    Abel, M.S.


    Six examples of a previously undescribed class of transverse vertebral element fractures are presented. These fractures differ from Chance and Smith fractures and their variants in the following respects: (1) the etiology is torsion and not flexion; (2) there is neither distraction of posterior ring fragments nor posterior ligament tears; (3) in contrast to Chance and Smith fractures, extension of the fracture into the vertebral body is absent or minimal; (4) the transverse process of the lumbar vertebra is avulsed at its base with a vertical fracture, not split horizontally. These fractures occur in cervical, lumbar, and sacral vertebrae in normal or compromised areas of the spine.

  1. Coupled Fracture and Flow in Shale in Hydraulic Fracturing (United States)

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


    Production of hydrocarbon from shale requires creation and maintenance of fracture permeability in an otherwise impermeable shale matrix. In this study, we use a combination of triaxial coreflood experiments and x-ray tomography characterization to investigate the fracture-permeability behavior of Utica shale at in situ reservoir conditions (25-50 oC and 35-120 bars). Initially impermeable shale core was placed between flat anvils (compression) or between split anvils (pure shear) and loaded until failure in the triaxial device. Permeability was monitored continuously during this process. Significant deformation (>1%) was required to generate a transmissive fracture system. Permeability generally peaked at the point of a distinct failure event and then dropped by a factor of 2-6 when the system returned to hydrostatic failure. Permeability was very small in compression experiments (conformed to Forscheimer's law. The coupled deformation and flow behavior of Utica shale, particularly the large deformation required to initiate flow, indicates the probable importance of activation of existing fractures in hydraulic fracturing and that these fractures can have adequate permeability for the production of hydrocarbon.

  2. Subtrochanteric fractures in bisphosphonate-naive patients

    DEFF Research Database (Denmark)

    Adachi, Jonathan D; Lyles, Kenneth; Boonen, Steven


    Our purpose was to characterize the risks of osteoporosis-related subtrochanteric fractures in bisphosphonate-naive individuals. Baseline characteristics of patients enrolled in the HORIZON-Recurrent Fracture Trial with a study-qualifying hip fracture were examined, comparing those who sustained...... incident subtrochanteric fractures with those sustaining other hip fractures. Subjects were bisphosphonate-naive or had a bisphosphonate washout period of 6-24 months and subsequently received an annual infusion of zoledronic acid 5 mg or placebo after low-trauma hip-fracture repair. In total, 2,127 men...... and women were included. Of the qualifying hip fractures, 5.2% were subtrochanteric, 54.8% femoral neck, 33.0% intertrochanteric, and 7.1% other (generally complex fractures of mixed type). Significant baseline (pre-hip fracture) differences were seen between index hip-fracture types, with the percentage...

  3. Compression fractures of the back (United States)

    Taking steps to prevent and treat osteoporosis is the most effective way to prevent compression or insufficiency fractures. Getting regular load-bearing exercise (such as walking) can help you avoid bone loss.


    NARCIS (Netherlands)

    Ocelik, Vaclav; DUHAJ, P; CSACH, K; MISKUF, J; BENGUS, VZ

    On the basis of measuring the mechanical properties and observing the fracture surface of an amorphous bilayer ribbon some partial conclusions on the mechanical quality of the bimetal boundary were drawn.

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

    DEFF Research Database (Denmark)

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


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

  6. Ankle Fractures Often Not Diagnosed (United States)

    ... injuries. Telltale signs of a fracture include bruising, blisters, significant swelling or bone protruding through the skin. ... for stability. She also advises buying from small shoe stores that have certified orthotists who work with ...

  7. Principles of Hand Fracture Management (United States)

    Haughton, DN; Jordan, D; Malahias, M; Hindocha, S; Khan, W


    The hand is essential in humans for physical manipulation of their surrounding environment. Allowing the ability to grasp, and differentiated from other animals by an opposing thumb, the main functions include both fine and gross motor skills as well as being a key tool for sensing and understanding the immediate surroundings of their owner. Hand fractures are the most common fractures presenting at both accident and emergency and within orthopaedic clinics. Appropriate evaluation at first presentation, as well as during their management, can significantly prevent both morbidity and disability to a patient. These decisions are dependant on a wide range of factors including age, hand dominance, occupation and co-morbidities. A fracture is best described as a soft tissue injury with an associated bony injury. Despite this being the case, this paper intends to deal mainly with the bone injury and aims to discuss both the timing, as well as the methods available, of hand fracture management. PMID:22423303

  8. The treatment of subtrochanteric fractures

    Directory of Open Access Journals (Sweden)

    Vučetić Čedomir S.


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

  9. Fractura bronquial BRONCHIAL FRACTURE

    Directory of Open Access Journals (Sweden)



    Full Text Available El traumatismo torácico es una entidad patológica emergente, relacionada con accidentes automovilísticos. La lesión más frecuente es la fractura costal. Dependiendo de su gravedad, éste puede provocar tórax volante, contusión cardíaca, lesiones vasculares u otras alteraciones. La ruptura bronquial se observa ocasionalmente en traumatismos torácicos cerrados, y por lo general tiene lugar en el tronco principal del árbol tráqueo-bronquial. Su diagnóstico y manejo inicial representan un problema mayor. Los signos clásicos son la persistencia de neumotórax y flujo masivo de aire a través del drenaje torácico; sin embargo también hay casos que no son típicos. Es difícil determinar el momento correcto para iniciar la ventilación mecánica con presión positiva, la que puede aumentar gravemente el flujo de aire a través de la ruptura bronquial y acentuar el neumotórax a tensión. Presentamos el caso de un hombre de 25 años con un traumatismo torácico cerrado, causado por un accidente de automóvil, en quien la broncoscopía demostró una fractura del bronquio lobar medio. Comprobamos en este paciente, que la fibrobroncoscopía es el procedimiento más útil tanto en el diagnóstico, como en el tratamiento inicial y en el seguimiento post operatorio de su fractura bronquiaThoracic trauma is an emerging pathology related to the increase of motor vehicle accidents. Rib fracture is the most frequent injury; depending on the severity of the event it may be associated with flail chest, cardiac contusion, vascular lesions and other injuries. Bronchial rupture is occasionally seen in blunt trauma and it occurs mostly in the main stem of the tracheobronchial tree. It represents a great task in diagnosis and initial management. Persistent pneumothorax and massive airflow by the thoracic drain are the classic signs, however other cases are not so typical. The right moment to begin positive pressure ventilation is challenging, because in

  10. New C2 synchondrosal fracture classification system

    Energy Technology Data Exchange (ETDEWEB)

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


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

  11. Mode I fracture toughness of coal

    Energy Technology Data Exchange (ETDEWEB)

    Bhagat, R.B.


    This investigation was undertaken to determine the fracture toughness and tensile strength of coal and to correlate these with the grindability of the coals in order to understand the fracture mechanics behaviour of coal. Results showed statistical relationships for the dependence of fracture toughness on the tensile strength of coal and between the fracture toughness and the Hardgrove Grindability Index. Softer coals have a lower fracture toughness value as coal is a brittle material. 16 references.

  12. [Scaphoid fracture in motocross riders]. (United States)

    Knobloch, K; Krämer, R; Redeker, J; Spies, M; Vogt, P M


    Motocross racing is a demanding motorcycling discipline with significant physiological and psychological demands. Upper extremity injuries are frequently encountered. Interestingly, motocross riders present with a significantly stronger left arm, even if the left hand is not dominant. This difference is attributed to the use of the clutch lever with the left hand, which is more frequent in motocross than in Enduro or desert rally. The wrist has been reported to be involved especially among motocross racers in contrast to road racing. Besides wrist fractures, scaphoid fractures have been previously without a detailed analysis of the injury mechanism. We report on three patients suffering scaphoid fractures caused by extreme hyperextension of the wrist during landing after a motocross jump. Two patients presented late three months following the initial trauma (both Herbert type C fractures), while one motocross athlete with a B 2-type scaphoid fracture was admitted to wrist surgery within a week. The B 2-type fracture was treated with open reduction and Herbert-screw fixation, while the C-type fractures were treated by Herbert-screw fixation in addition to a cortico-cancellous bone graft. Within ten weeks after the surgery the patients were back in sport at their given preoperative level. Hyperextension rather than wrist flexion appears as the predominant mechanism of wrist injuries in motocross riders. A more axial impact on the wrist is more likely to produce a radial fracture during the landing phase. Preventive strategies are internal muscular wrist stabilisation using eccentric training and external stabilisation by rigid gloves allowing only limited hyperextension.

  13. Fracturing fluid characterization facility (FFCF)

    Energy Technology Data Exchange (ETDEWEB)

    Evans, R.D.; Roegiers, J.C.; Fagan, J.


    The Fracturing Fluid Characterization Facility project has as its main focus the design, fabrication, and construction of a high pressure simulator (HPS) and a low pressure simulator (LPS) to be used to experimentally investigate the rheological properties and transport characteristics of proppant laden fracturing fluids. A discussion of each apparatus is provided as well as the auxiliary equipment, and data acquisition and control systems associated with the simulators.

  14. Intergranular fracture in nanocrystalline metals (United States)

    Farkas, D.; van Swygenhoven, H.; Derlet, P. M.


    Crack propagation studies in nanocrystalline Ni samples with mean grain sizes ranging from 5 to 12 nm are reported using atomistic simulations. For all grain sizes pure intergranular fracture is observed. Intergranular fracture is shown to proceed by the coalescence of microvoids formed at the grain boundaries ahead of the crack. The energy released during propagation is higher than the Griffith value, indicating an additional grain-boundary accommodation mechanism.

  15. Infection in periprosthetic hip fractures. (United States)

    Cabral, Rui


    Fracture around the acetabulum and femur in total hip arthroplasty is a possible complication, sometimes with difficult surgical solution, namely when a sepsis is present. Periprosthetic hip fractures were classified according to a modified Vancouver classification. We treated 112 patients (67 men and 45 women) with periprosthetic hip fractures: 105 femoral fractures (94%) and seven acetabular fractures (6%). Mean follow-up was 10.6 years. For Type A (seven cases - 7%), B1 (10 cases - 10%) or C (13 cases - 12%) fractures around well fixed femoral stems we only fixed the fractures. For Type B2 (17 cases - 16%), B3 (46 cases - 44%) and D (12 cases - 11%, with associated fractures, not contemplated in the Vancouver classification) we used an uncemented long femoral stem, fixation with metallic cables and cancellous bone allografts to fill the femoral bone loss. We observed a deep infection in three patients (2.7%), three early hip dislocations treated by closed reductions, two cases with asymptomatic trochanteric non-union and one femoral refracture. In the three infection cases we performed two-stage revision with cementless hip prosthesis, using an antibiotic-loaded cement hip spacer (three to eight months), a six weeks period of parenteral antibiotics and we performed articular aspiration before revision surgery. Until now, we did not observe any re-infection. It is very important to make an early diagnosis, isolate micro-organisms and ensure their antibiotic susceptibility. The surgery solution depends on the well fixed implants and periprosthetic osteolysis and articular instability.

  16. Definition, classification and treatment of destructive fractures

    Institute of Scientific and Technical Information of China (English)

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


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

  17. Maisonneuve-hyperplantarflexion variant ankle fracture. (United States)

    Hinds, Richard M; Tran, Wesley H; Lorich, Dean G


    Maisonneuve fractures are rare ankle injuries, accounting for up to 7% of all ankle fractures. They consist of a proximal third fibula fracture, syndesmotic disruption, and medial ankle injury (either a deltoid ligament disruption or a medial malleolus fracture), and are often successfully managed with nonoperative treatment of the proximal fibula fracture and open reduction and internal fixation (ORIF) of the medial ankle injury and syndesmotic disruption. The hyperplantarflexion variant ankle fracture comprises approximately 7% of all ankle fractures and features dual posterior tibial lip fractures featuring a posterolateral fragment and a posteromedial fragment. Good functional results have been reported in the literature after ORIF of both the posterolateral and posteromedial fragments of this variant fracture that is not described by the Lauge-Hansen classification. In this report, the authors present the unique case of an isolated ankle fracture demonstrating characteristics of both a Maisonneuve fracture and a hyperplantarflexion variant ankle fracture. They also highlight the diagnostic imaging characteristics, including magnetic resonance imaging (MRI) and preoperative radiograph findings, surgical treatment, and postoperative clinical outcome for this patient with a Maisonneuve-hyperplantarflexion variant ankle fracture. To the authors' knowledge, this unique fracture pattern has not been reported previously in the literature. The authors conclude that although good results were seen postoperatively in this case, the importance of ORIF of both the posteromedial and posterolateral fragments of variant fractures cannot be overstated. They also found MRI to be a particularly helpful adjunct in formulating the correct diagnosis and treatment plan.

  18. Bilateral Monteggia fracture in adults

    Directory of Open Access Journals (Sweden)

    Ristić Dejan


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

  19. Epidemiology of tibial shaft fractures

    Directory of Open Access Journals (Sweden)

    Grecco Marco Aurélio Sertório


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

  20. Meshless Animation of Fracturing Solids (United States)

    Pauly, Mark; Keiser, Richard; Adams, Bart; Dutré, Philip; Gross, Markus; Guibas, Leonidas J.


    We present a new meshless animation framework for elastic and plastic materials that fracture. Central to our method is a highly dynamic surface and volume sampling method that supports arbitrary crack initiation, propagation, and termination, while avoiding many of the stability problems of traditional mesh-based techniques. We explicitly model advancing crack fronts and associated fracture surfaces embedded in the simulation volume. When cutting through the material, crack fronts directly affect the coupling between simulation nodes, requiring a dynamic adaptation of the nodal shape functions. We show how local visibility tests and dynamic caching lead to an efficient implementation of these effects based on point collocation. Complex fracture patterns of interacting and branching cracks are handled using a small set of topological operations for splitting, merging, and terminating crack fronts. This allows continuous propagation of cracks with highly detailed fracture surfaces, independent of the spatial resolution of the simulation nodes, and provides effective mechanisms for controlling fracture paths. We demonstrate our method for a wide range of materials, from stiff elastic to highly plastic objects that exhibit brittle and/or ductile fracture. PMID:21165160

  1. Fracture behaviour of polycrystalline tungsten (United States)

    Gaganidze, Ermile; Rupp, Daniel; Aktaa, Jarir


    Fracture behaviour of round blank polycrystalline tungsten was studied by means of three point bending Fracture-Mechanical (FM) tests at temperatures between RT and 1000 °C and under high vacuum. To study the influence of the anisotropic microstructure on the fracture toughness (FT) and ductile-to-brittle transition (DBT) the specimens were extracted in three different, i.e. longitudinal, radial and circumferential orientations. The FM tests yielded distinctive fracture behaviour for each specimen orientation. The crack propagation was predominantly intergranular for longitudinal orientation up to 600 °C, whereas transgranular cleavage was observed at low test temperatures for radial and circumferentially oriented specimens. At intermediate test temperatures the change of the fracture mode took place for radial and circumferential orientations. Above 800 °C all three specimen types showed large ductile deformation without noticeable crack advancement. For longitudinal specimens the influence of the loading rate on the FT and DBT was studied in the loading rate range between 0.06 and 18 MPa m1/2/s. Though an increase of the FT was observed for the lowest loading rate, no resolvable dependence of the DBT on the loading rate was found partly due to loss of FT validity. A Master Curve approach is proposed to describe FT vs. test temperature data on polycrystalline tungsten. Fracture safe design space was identified by analysis compiled FT data.

  2. The influence of elastic modulus of inlay materials on stress distribution and fracture of premolars. (United States)

    Costa, Akf; Xavier, Ta; Noritomi, Py; Saavedra, G; Borges, Als


    SUMMARY The purpose of this study was to evaluate the influence the width of the occlusal isthmus and inlay material had on the stress distribution, displacement, and fracture resistance of upper human premolars. For this in vitro test, 35 intact upper premolars (UPM) were selected and five were kept intact for the control group (group I). The remaining 30 were divided into two experimental groups (n=15) according to the width of isthmus: conservative (CP) and extensive preparation (EP), one third and more than two thirds of cuspal distance, respectively. Five teeth from each experimental group were left without restoration for negative controls (CPnc and EPnc), and the remaining 10 in each group were subdivided according to the inlay material (resin or ceramic): group CPr, CP + indirect resin; group CPc, CP + ceramic; group EPr, EP + indirect resin; and group EPc, EP + ceramic. The cemented inlays were loaded in a universal testing machine at a crosshead speed of 0.5 mm/min until fracture. The fractured specimens were analyzed with stereomicroscopy, and the values of the fracture resistance evaluated by analysis of variance and Tukey test. For the finite element analyses, an average UPM for each group was modeled in Rhinoceros CAD software and imported to Ansys 13.0. An average of 320,000 tetrahedral elements and 540,000 nodes for the seven models were performed using the same experimental simulation setup for each. The models were constrained on the base, and a displacement of 0.02 mm was applied to keep a linear behavior for the analysis. A von Mises stress and total displacement fields were used for the coherence test and the maximum principal stress fields were used for mechanical behavior comparisons. Group I (161.73 ± 22.94) showed a significantly higher mean value than the other experimental groups (EPc: 103.55 ± 15.84; CPc: 94.38 ± 12.35; CPr: 90.31 ± 6.10; EPr: 65.42 ± 10.15; CPnc: 65.46 ± 5.37; EPnc: 58.08 ± 9.62). The stress distribution was

  3. Prevention of arthrofibrosis after arthroscopic screw fixation of tibial spine fracture in children and adolescents. (United States)

    Parikh, Shital N; Myer, David; Eismann, Emily A


    Arthrofibrosis is a major complication of tibial spine fracture treatment in children, potentially resulting in knee pain, quadriceps weakness, altered gait, decreased function, inability to return to sports, and long-term osteoarthritis. Thus, prevention rather than treatment of arthrofibrosis is desirable. The purpose of this study was to evaluate an aggressive postoperative rehabilitation and early intervention approach to prevent permanent arthrofibrosis after tibial spine fracture treatment and to compare epiphyseal and transphyseal screws for fixation. A consecutive series of 24 patients younger than age 18 with displaced type II and III tibial spine fractures who underwent arthroscopic reduction and screw fixation between 2006 and 2011 were retrospectively reviewed. Final range of motion was compared between patients with epiphyseal (n=12) and transphyseal (n=9) screws. One-third (4 of 12) of patients with epiphyseal screws underwent arthroscopic debridement and screw removal approximately 3 months postoperatively; 3 patients lacked 5° to 15° of extension, 1 experienced pain with extension, and 1 had radiographic evidence of screw pullout, loss of reduction, and resultant malunion. In the transphyseal screw group, 3 patients had 10° loss of extension, and all corrected after arthroscopic debridement and screw removal. The two groups did not significantly differ in time to hardware removal or return to sports or final range of motion. No growth disturbances were identified in patients after transphyseal screw removal. An aggressive approach of postoperative rehabilitation and early intervention after arthroscopic reduction and screw fixation of tibial spine fractures in children was successful in preventing permanent arthrofibrosis.

  4. Optimal scaling in ductile fracture (United States)

    Fokoua Djodom, Landry

    This work is concerned with the derivation of optimal scaling laws, in the sense of matching lower and upper bounds on the energy, for a solid undergoing ductile fracture. The specific problem considered concerns a material sample in the form of an infinite slab of finite thickness subjected to prescribed opening displacements on its two surfaces. The solid is assumed to obey deformation-theory of plasticity and, in order to further simplify the analysis, we assume isotropic rigid-plastic deformations with zero plastic spin. When hardening exponents are given values consistent with observation, the energy is found to exhibit sublinear growth. We regularize the energy through the addition of nonlocal energy terms of the strain-gradient plasticity type. This nonlocal regularization has the effect of introducing an intrinsic length scale into the energy. We also put forth a physical argument that identifies the intrinsic length and suggests a linear growth of the nonlocal energy. Under these assumptions, ductile fracture emerges as the net result of two competing effects: whereas the sublinear growth of the local energy promotes localization of deformation to failure planes, the nonlocal regularization stabilizes this process, thus resulting in an orderly progression towards failure and a well-defined specific fracture energy. The optimal scaling laws derived here show that ductile fracture results from localization of deformations to void sheets, and that it requires a well-defined energy per unit fracture area. In particular, fractal modes of fracture are ruled out under the assumptions of the analysis. The optimal scaling laws additionally show that ductile fracture is cohesive in nature, i.e., it obeys a well-defined relation between tractions and opening displacements. Finally, the scaling laws supply a link between micromechanical properties and macroscopic fracture properties. In particular, they reveal the relative roles that surface energy and microplasticity

  5. A 3-Dimensional discrete fracture network generator to examine fracture-matrix interaction using TOUGH2

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Kazumasa; Yongkoo, Seol


    Water fluxes in unsaturated, fractured rock involve the physical processes occurring at fracture-matrix interfaces within fracture networks. Modeling these water fluxes using a discrete fracture network model is a complicated effort. Existing preprocessors for TOUGH2 are not suitable to generate grids for fracture networks with various orientations and inclinations. There are several 3-D discrete-fracture-network simulators for flow and transport, but most of them do not capture fracture-matrix interaction. We have developed a new 3-D discrete-fracture-network mesh generator, FRACMESH, to provide TOUGH2 with information about the fracture network configuration and fracture-matrix interactions. FRACMESH transforms a discrete fracture network into a 3 dimensional uniform mesh, in which fractures are considered as elements with unique rock material properties and connected to surrounding matrix elements. Using FRACMESH, individual fractures may have uniform or random aperture distributions to consider heterogeneity. Fracture element volumes and interfacial areas are calculated from fracture geometry within individual elements. By using FRACMESH and TOUGH2, fractures with various inclinations and orientations, and fracture-matrix interaction, can be incorporated. In this paper, results of flow and transport simulations in a fractured rock block utilizing FRACMESH are presented.

  6. [Bone fracture and the healing mechanisms. Fragility fracture and bone quality]. (United States)

    Mawatari, Taro; Iwamoto, Yukihide


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

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

    Institute of Scientific and Technical Information of China (English)

    Ramji Lal Sahu; Rajni Ranjan; Ajay Lal


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


    Institute of Scientific and Technical Information of China (English)

    Yang Xinhua; Chen Chuanyao; Hu Yuantai; Wang Cheng


    Mechanical and electrical damages are introduced to study the fracture mechanics of piezoelectric ceramics in this paper. Two kinds of piezoelectric fracture criteria are established using the method of least squares combined with a damage analysis of the well-known piezoelectric fracture experiments of Park and Sun's. One is based on a linear combination of the mechanical and electrical damages and the other on their nonlinear combination. When the combined damage D is up to its critical value Dc, piezoelectric fracture occurs. It is found from the qualitative comparison of the numerical results with the experimental data that the nonlinearly combined damage fracture criterion can give a better prediction of piezoelectric fracture. And it is concluded from the nonlinearly combined damage fracture criterion that a negative electric field impedes fracture whereas the effect of a positive electric field on fracture depends on its magnitude.

  9. Fractal modeling of natural fracture networks

    Energy Technology Data Exchange (ETDEWEB)

    Ferer, M.; Dean, B.; Mick, C.


    West Virginia University will implement procedures for a fractal analysis of fractures in reservoirs. This procedure will be applied to fracture networks in outcrops and to fractures intersecting horizontal boreholes. The parameters resulting from this analysis will be used to generate synthetic fracture networks with the same fractal characteristics as the real networks. Recovery from naturally fractured, tight-gas reservoirs is controlled by the fracture network. Reliable characterization of the actual fracture network in the reservoir is severely limited. The location and orientation of fractures intersecting the borehole can be determined, but the length of these fractures cannot be unambiguously determined. Because of the lack of detailed information about the actual fracture network, modeling methods must represent the porosity and permeability associated with the fracture network, as accurately as possible with very little a priori information. In the sections following, the authors will (1) present fractal analysis of the MWX site, using the box-counting procedure; (2) review evidence testing the fractal nature of fracture distributions and discuss the advantages of using the fractal analysis over a stochastic analysis; and (3) present an efficient algorithm for producing a self-similar fracture networks which mimic the real MWX outcrop fracture network.

  10. Growth Kinematics of Opening-Mode Fractures (United States)

    Eichhubl, P.; Alzayer, Y.; Laubach, S.; Fall, A.


    Fracture aperture is a primary control on flow in fractured reservoirs of low matrix permeability including unconventional oil and gas reservoirs and most geothermal systems. Guided by principles of linear elastic fracture mechanics, fracture aperture is generally assumed to be a linear function of fracture length and elastic material properties. Natural opening-mode fractures with significant preserved aperture are observed in core and outcrop indicative of fracture opening strain accommodated by permanent solution-precipitation creep. Fracture opening may thus be decoupled from length growth if the material effectively weakens after initial elastic fracture growth by either non-elastic deformation processes or changes in elastic properties. To investigate the kinematics of fracture length and aperture growth, we reconstructed the opening history of three opening-mode fractures that are bridged by crack-seal quartz cement in Travis Peak Sandstone of the SFOT-1 well, East Texas. Similar crack-seal cement bridges had been interpreted to form by repeated incremental fracture opening and subsequent precipitation of quartz cement. We imaged crack-seal cement textures for bridges sampled at varying distance from the tips using scanning electron microscope cathodoluminescence, and determined the number and thickness of crack-seal cement increments as a function of position along the fracture length and height. Observed trends in increment number and thickness are consistent with an initial stage of fast fracture propagation relative to aperture growth, followed by a stage of slow propagation and pronounced aperture growth. Consistent with fluid inclusion observations indicative of fracture opening and propagation occurring over 30-40 m.y., we interpret the second phase of pronounced aperture growth to result from fracture opening strain accommodated by solution-precipitation creep and concurrent slow, possibly subcritical, fracture propagation. Similar deformation

  11. Rare stress fracture: longitudinal fracture of the femur. (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.

  12. Treatment of pediatric femoral shaft fractures by stainless steel and titanium elastic nail system: A randomized comparative trial

    Institute of Scientific and Technical Information of China (English)

    Tank Gyaneshwar; Rustagi Nitesh; Tomar Sagar; Kothiyal Pranav; Nitesh Rustagi


    observed in titanium group but five in stainless steel group.Conclusion:Majority of paediatric femoral shaft fractures are now treated operatively by elastic stable intramedullary nails.Operative intervention results in a shorter hospital stay and has economic and social benefits over conservative treatment.The cost of stainless steel nail is one third the cost of titanium nail.However,the clinico-radiological results are not significantly different between titanium and stainless steel nails at one year follow-up as observed by our study.

  13. Fracture and Medium Modeling, by Analizing Hidraulic Fracturing Induced Microseismicity (United States)

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


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

  14. High prevalence of simultaneous rib and vertebral fractures in patients with hip fracture. (United States)

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


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

  15. Discrete modeling of hydraulic fracturing processes in a complex pre-existing fracture network (United States)

    Kim, K.; Rutqvist, J.; Nakagawa, S.; Houseworth, J. E.; Birkholzer, J. T.


    Hydraulic fracturing and stimulation of fracture networks are widely used by the energy industry (e.g., shale gas extraction, enhanced geothermal systems) to increase permeability of geological formations. Numerous analytical and numerical models have been developed to help understand and predict the behavior of hydraulically induced fractures. However, many existing models assume simple fracturing scenarios with highly idealized fracture geometries (e.g., propagation of a single fracture with assumed shapes in a homogeneous medium). Modeling hydraulic fracture propagation in the presence of natural fractures and homogeneities can be very challenging because of the complex interactions between fluid, rock matrix, and rock interfaces, as well as the interactions between propagating fractures and pre-existing natural fractures. In this study, the TOUGH-RBSN code for coupled hydro-mechanical modeling is utilized to simulate hydraulic fracture propagation and its interaction with pre-existing fracture networks. The simulation tool combines TOUGH2, a simulator of subsurface multiphase flow and mass transport based on the finite volume approach, with the implementation of a lattice modeling approach for geomechanical and fracture-damage behavior, named Rigid-Body-Spring Network (RBSN). The discrete fracture network (DFN) approach is facilitated in the Voronoi discretization via a fully automated modeling procedure. The numerical program is verified through a simple simulation for single fracture propagation, in which the resulting fracture geometry is compared to an analytical solution for given fracture length and aperture. Subsequently, predictive simulations are conducted for planned laboratory experiments using rock-analogue (soda-lime glass) samples containing a designed, pre-existing fracture network. The results of a preliminary simulation demonstrate selective fracturing and fluid infiltration along the pre-existing fractures, with additional fracturing in part

  16. Plain film analysis of acetabular fracture

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Chang Soo; Han, Sang Suk; Yoon, Eu Giene; Cha, Seong Sook; Eun, Tchoong Kie; Chung, Duck Hwan [Inje Medical College Paik Hospital, Pusan (Korea, Republic of)


    Acetabular fracture can result in severe limitation of the motion of the hip joint, which supports total weight of human body. Because of different methods of surgical approach according to fracture type, precise interpretation of X-ray films of acetabular fracture is required. We reviewed 38 cases of simple X-ray films showing acetabular fracture. The results were as follows: 1. Almost 60% of the cases-were in their 2nd and 3rd decades. 2. Twenty cases were male, and 18 cases were female. 3. The most common cause of the injury was traffic accident (33 cases, 86.8%), followed by fall down (4 cases, 10.5%), and slip down (1 case, 2.7%). 4. Elementary fractures were 21 cases (55.3%), and associated fractures were 17 cases (44.7%). 5. Among elementary fractures, posterior wall fractures were 9 cases (23.7%), followed by anterior column fractures (8 cases, 21.1%), anterior wall fractures (4 cases, 10.5%). 6. Among associated fractures, T-shaped fractures were 8 cases (21.1%), followed by both column fractures (6 cases, 15.8%), anterior and hemitransverse fractures (3 cases, 7.8%). 7. Other pelvic bone fractures associated with the acetabular fracture were as follows: fractures of contralateral pubic rami (6 cases, 15.8%) contralateral iliac bone (1 case, 2.6%) and ipsilateral iliac bone (1 case, 2.6%). 8. Injuries of other organs adjacent to the acetabulum were as follows: rupture of the bladder (3 cases, 7.9%), urethra (2 cases, 5.3%) and uterus (1 cases, 2.6%)


    Directory of Open Access Journals (Sweden)

    Stjepan Antolović


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

  18. Fracture mechanics of PGX graphite

    Energy Technology Data Exchange (ETDEWEB)

    Ho, F.H.; Vollman, R.E.; Cull, A.D.


    Fracture mechanics tests were performed on grade PGX graphite. A compact tension specimen configuration which yields consistent values of the opening mode critical stress intensity factor K/sub IC/, was designed. For the calculation of the fracture toughness and crack growth rate the concept of the effective crack length is used. It corresponds to the crack length of a machined notched specimen with the same compliance. Fracture toughness testing was performed in two environments, air and helium, both at room temperature. The critical stress intensity factor, K/sub IC/, is calculated based on the maximum load and the effective crack length. The fatigue crack growth test was performed in air only. A break-in period was observed for the machined notch to develop into a naturally occurring crack path. Half of the fatigue life was spent in this period.

  19. MR imaging of scaphoid fractures

    DEFF Research Database (Denmark)

    Meincke, Louise; Radev, Dimitar; Eriksen, Rie Østbjerg


    Objective: Traumatic injuries of os scaphoideum are serious, and might lead to two main grades of consequences (i.e. osteoarthrosis or avascular necrosis), if a fracture remains undiagnosed. Bone bruise may be the only pathological sign of pain which can last for week or month. Articles describe......). Materials and methods: Two hundred and fifty-one patients with relevant trauma and positive clinical test for scaphoid bone fractures, exceeding no more than 14 days, underwent MRI examinations. A fast STIR and T2 FAT SAT fast spin echo sequence (FSE) were obtained using a comparable parameter setting (scan...... of scaphoid fractures Results: There were no significant difference between the bone bruise areas (P=0.45, P=0.44 and P=0.83) or CNR (P=0.31, P=0.38 and P=0.17). However, image contrast showed significant difference in favour of T2 FAT SAT in all three readers’ reports (P

  20. Lateral malleolus hook plate for comminuted Weber A and B fractures: A retrospective study

    Directory of Open Access Journals (Sweden)

    Fang Zhenhua


    Full Text Available Background: The goal of managing the comminuted fracture of lateral malleolus is to restore length, rotation and alignment which might be more challenging with extensive comminution around the area of the distal tip. The common osteosynthesis techniques such as the one-third tubular plate, tension band wiring, K-wires, screws, or intramedullary nail may be insufficient in cases with a comminuted lateral malleolus. The anatomical hook plate is an alternative implant in such cases. We present our results of the comminuted lateral malleolar fractures (Weber A, B, managed by open reduction and internal fixation (ORIF with an anatomical hook plate of lateral malleolus (Königsee Implant Company, Germany. Materials and Methods: We retrospectively reviewed 20 patients of comminuted fracture of distal lateral malleolus between 2008 and 2010. There were 12 males and 8 females, right side was involved in 18 patients and left in 2. The mean age was 51.9 years (range 18-75 years. The fractures were categorized by Denis-Weber classification type A (n=1, B1 (n=1, B2 (n=13 and B3 (n=5. Nineteen cases were of closed injury and one of open injury (Gustilo Anderson type II. These patients underwent ORIF with a lateral malleolus anatomical hook plate. Followup including radiographs and clinical examinations were performed. The American Orthopedic Foot and Ankle Society (AOFAS ankle hindfoot scores were documented at followups. Results: The mean followup was 21.4 months (range 16-27 months. The average AOFAS score was 94.3 (range 78-100 points. A stable anatomic reduction and bony union were obtained in all the cases. The average time was 3.1 months (range 2.5-4 months. Four cases had complications like posttraumatic osteoarthritis, hardware impingement and superficial wound infection. Conclusion: A reasonably good stability can be obtained in distal most comminuted fractures of lateral malleolus with a lateral malleolus anatomical hook plate. We believe this

  1. Subtask 12F4: Effects of neutron irradiation on the impact properties and fracture behavior of vanadium-base alloys

    Energy Technology Data Exchange (ETDEWEB)

    Chung, H.M.; Loomis, B.A.; Smith, D.L. [Argonne National Lab., IL (United States)


    Up-to-date results on the effects of neutron irradiation on the impact properties and fracture behavior of V, V-Ti, V-Cr-Ti and V-Ti-Si alloys are presented in this paper, with an emphasis on the behavior of the U.S. reference alloys V-4Cr-4Ti containing 500-1000 wppm Si. Database on impact energy and cluctile-brittle transition temperature (DBTT) has been established from Charpy impact tests of one-third-size specimens irradiated at 420{degrees}C-600{degrees}C up to {approx}50 dpa in lithium environment in fast fission reactors. To supplement the Charpy impact tests fracture behavior was also characterized by quantitative SEM fractography on miniature tensile and disk specimens that were irradiated to similar conditions and fractured at -196{degrees}C to 200{degrees}C by multiple bending. For similar irradiation conditions irradiation-induced increase in DBTT was influenced most significantly by Cr content, indicating that irradiation-induced clustering of Cr atoms takes place in high-Cr (Cr {ge} 7 wt.%) alloys. When combined contents of Cr and Ti were {le}10 wt.%, effects of neutron irradiation on impact properties and fracture behavior were negligible. For example, from the Charpy-impact and multiple-bend tests there was no indication of irradiation-induced embrittlement for V-5Ti, V-3Ti-1Si and the U.S. reference alloy V-4Cr-4Ti after irradiation to {approx}34 dpa at 420{degrees}C to 600{degrees}C, and only ductile fracture was observed for temperatures as low as -196{degrees}C. 14 refs., 8 figs., 1 tab.

  2. Dynamic fracture of heterogeneous materials

    Energy Technology Data Exchange (ETDEWEB)

    Stout, M.G.; Liu, C.; Addessio, F.L.; Williams, T.O.; Bennett, J.G.; Haberman, K.S.; Asay, B.W.


    This is the final report of a one-year, Laboratory Directed Research and Development (LDRD) project at the Los Alamos National Laboratory (LANL). The objective of this project was to investigate the fundamental aspects of the process of dynamic fracture propagation in heterogeneous materials. The work focused on three important, but poorly understood, aspects of dynamic fracture for materials with a heterogeneous microstructure. These were: the appropriateness of using a single-parameter asymptotic analysis to describe dynamic crack-tip deformation fields, the temperature rises at the tip and on the flanks of a running crack, and the constitutive modeling of damage initiation and accumulation.

  3. Hydrogen fracture toughness tester completion

    Energy Technology Data Exchange (ETDEWEB)

    Morgan, Michael J. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)


    The Hydrogen Fracture Toughness Tester (HFTT) is a mechanical testing machine designed for conducting fracture mechanics tests on materials in high-pressure hydrogen gas. The tester is needed for evaluating the effects of hydrogen on the cracking properties of tritium reservoir materials. It consists of an Instron Model 8862 Electromechanical Test Frame; an Autoclave Engineering Pressure Vessel, an Electric Potential Drop Crack Length Measurement System, associated computer control and data acquisition systems, and a high-pressure hydrogen gas manifold and handling system.

  4. Trapezoid fracture caused by assault

    Directory of Open Access Journals (Sweden)

    Malshikare V


    Full Text Available In this report we describe an open fracture of trapezoid and break in anterior cortex of capitate due to assault in a young adult male. Direct impact force of a sharp object to the first web space caused the above fractures. Open reduction and internal fixation of the trapezoid was carried out using Kirschner wires. Cut extensor tendons, extensor retaniculum, capsule, adductor pollicis muscle, first dorsal interosseous muscle, soft tissue and overlying skin were sutured primarily. Three months after the operation the patient has made a complete recovery. There is no similar case reported in the literature.

  5. Arthrofibrosis After Periarticular Fracture Fixation. (United States)

    McAlister, Ian; Sems, Stephen Andrew


    Arthrofibrosis after periarticular fractures can create clinically significant impairments in both the upper and lower extremities. The shoulder, elbow, and knee are particularly susceptible to the condition. Many risk factors for the development of arthrofibrosis cannot be controlled by the patient or surgeon. Early postoperative motion should be promoted whenever possible. Manipulations under anesthesia are effective for a period of time in certain fracture patterns, and open or arthroscopic surgical debridements should be reserved for the patient for whom nonoperative modalities fail and who has a clinically significant deficit. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. [Vertical fractures: apropos of 2 clinical cases]. (United States)

    Félix Mañes Ferrer, J; Micò Muñoz, P; Sánchez Cortés, J L; Paricio Martín, J J; Miñana Laliga, R


    The aim of the study is to present a clinical review of the vertical root fractures. Two clinical cases are presented to demonstrates the criteria for obtaining a correct diagnosis of vertical root fractures.

  7. [Iatrogenic evolutive skull fracture (author's transl)]. (United States)

    Villarejo, F; Pascual Castroviejo, I; Dabdoub, C; Bordes, M; Jover, P


    A case of growing skull fracture secondary to a maxilofacial operation is reported. Frequency, clinical symptoms, phisiopathology and treatment of growing skull fractures are reviewed and the rarity of the iatrogenic mechanism is stressed.

  8. Subclinical Thyroid Dysfunction and Fracture Risk

    DEFF Research Database (Denmark)

    Blum, Manuel R; Bauer, Douglas C; Collet, Tinh-Hai


    IMPORTANCE: Associations between subclinical thyroid dysfunction and fractures are unclear and clinical trials are lacking. OBJECTIVE: To assess the association of subclinical thyroid dysfunction with hip, nonspine, spine, or any fractures. DATA SOURCES AND STUDY SELECTION: The databases of MEDLI...


    Institute of Scientific and Technical Information of China (English)

    Li-yang Dai


    Objective To review imaging use in the diagnosis ofthoracolumbar burst fractures and to determine the diagnostic value of different imaging methods.Methods One hundred and fourteen patients with 120 thoracolumbar burst fractures were retrospectively reviewed. Plain radiographs were available in all cases; CT scans and MRI were obtained in 96 and 74 cases, respectively.Results A total of 27 burst fractures were misdiagnosed as other types of fractures on radiographs alone, and accounted for 22.5% of all fractures. The results indicated that plain radiographs often fail to delineate the pathological features of thoracolumbar burst fractures, leading to delay in diagnosis.Conclusion In regard to thoracolumbar injury diagnosis, burst fractures should be differentiated from compression fractures. CT should be routinely indicated and MRI examination, when necessary, may be simultaneously considered.

  10. Surgical treatment for complicated acetabular fractures

    Institute of Scientific and Technical Information of China (English)

    Ning An; Yang Yanmin


    Objective: To sum up the surgical approaches and clinical outcome of complicated acetabular fractures. Methods: 17 patients with complicated acetabular fractures (including 4 cases of transverse with posterior wall fractures, 7 cases of posterior column and wall fractures, 4 cases of anterior and posterior columns fractures, 1 cases of T-type fracture and 1 cases of anterior column with posterior hemitransverse fractures) underwent open reduction and internal fixation with screws and plates by Kocher-Langenbeck (8 cases), ilio-inguinal (2 cases), extended iliofemoral (4 cases) or ilio-inguinal combined with K-L approaches (3 cases). Results: 12 patients with anatomical reduction, 4 patients with satisfactory reduction and 1 patient with non-satisfactory reduction. 15 out of 17 cases were followed up for 6 months to 5 years, and the excellent and good rate was 70.5%. Conclusion: Surgical treatment for complicated acetabular fractures can get a satisfactory reduction and a good clinical outcome.

  11. Topological impact of constrained fracture growth

    Directory of Open Access Journals (Sweden)

    Sigmund Mongstad Hope


    Full Text Available The topology of two discrete fracture network models is compared to investigate the impact of constrained fracture growth. In the Poissonian discrete fracture network model the fractures are assigned length, position and orientation independent of all other fractures, while in the mechanical discrete fracture network model the fractures grow and the growth can be limited by the presence of other fractures. The topology is found to be impacted by both the choice of model, as well as the choice of rules for the mechanical model. A significant difference is the degree mixing. In two dimensions the Poissonian model results in assortative networks, while the mechanical model results in disassortative networks. In three dimensions both models produce disassortative networks, but the disassortative mixing is strongest for the mechanical model.


    African Journals Online (AJOL)


    Nov 11, 2001 ... confirmed mandibular fractures seen in children who were treated at the Department of Oral ... fractures were due to sport injuries. Other causes were .... young children and to prevent temporomandibular joint ankylosis as a ...

  13. Toe and Metatarsal Fractures (Broken Toes) (United States)

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

  14. Deep gold mine fracture zone behaviour

    CSIR Research Space (South Africa)

    Napier, JAL


    Full Text Available The investigation of the behaviour of the fracture zone surrounding deep level gold mine stopes is detailed in three main sections of this report. Section 2 outlines the ongoing study of fundamental fracture process and their numerical...

  15. Fracture Union in Closed Interlocking Nail in Femoral Fracture

    Directory of Open Access Journals (Sweden)

    R L Sahu


    Full Text Available INTRODUCTION: Fractures shaft femur is a major cause of morbidity and mortality in patients with lower extremity injuries. The objective of this study was to find out the outcome of Interlocking nail in fracture femur. METHODS: This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2006 to November 2008. Seventy eight patients were recruited from Emergency and out patient department having closed fracture of femoral shaft. All patients were operated under general or spinal anesthesia. All patients were followed for nine months. RESULTS: Out of seventy eight patients, sixty nine patients underwent union in 90 to 150 days with a mean of 110.68 days. Touch down weight bearing was started on 2nd post-operative day. Complications found in four patients who had non-union, and five patients had delayed union which was treated with dynamization and bone graft. The results were excellent in 88.46% and good in 6.41% patients. CONCLUSIONS: We concluded that this technique is advantageous because of early mobilization (early weight bearing, less complication with good results and is economical. Keywords: close reamed interlocking nail, dynamization, femoral shaft fractures, union

  16. Fracture Rates and Fracture Sites in Patients With Osteogenesis Imperfecta

    DEFF Research Database (Denmark)

    Folkestad, Lars; Hald, Jannie Dahl; Ersbøll, Annette Kjær;


    Osteogenesis imperfecta (OI) is a hereditary, clinically heterogeneous, connective tissue disorder. The population prevalence of OI in Denmark is 10.6 in 100,000. A hallmark of the disease is frequent fractures that are often precipitated by minimal trauma. The aim of the current study...

  17. Characterisation of hydraulically-active fractures in a fractured ...

    African Journals Online (AJOL)


    Jan 7, 2015 ... maximum depth of the tunnel is 90–100 m from the peak of a mountain located above the .... g is the gravity acceleration l is the length of the test ..... process and is a hydraulically-active fracture conducting ground- water flow.

  18. Quantifying Fracture Heterogeneity in Different Domains of Folded Carbonate Rocks to Improve Fractured Reservoir Analog Fluid Flow Models

    NARCIS (Netherlands)

    Bisdom, K.; Bertotti, G.; Gauthier, B.D.M.; Hardebol, N.J.


    Fluid flow in carbonate reservoirs is largely controlled by multiscale fracture networks. Significant variations of fracture network porosity and permeability are caused by the 3D heterogeneity of the fracture network characteristics, such as intensity, orientation and size. Characterizing fracture

  19. 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


    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.

  20. Interpretation of stress damage on fracture conductivity

    Energy Technology Data Exchange (ETDEWEB)

    Berumen, Sergio; Tiab, Djebbar [PEMEX E and P and The University of Oklahoma, School of Petroleum and Geological Engineering, Norman, OK (United States)


    This paper focuses on the investigation of pressure responses in a well producing through a composite system of a stress-sensitive vertical symmetric or asymmetric fracture interacting with a stress-sensitive permeable-porous medium. Results of this investigation demonstrate that when the fracture conductivity is stress dependent, the use of conventional techniques to evaluate fractured wells may lead to incorrect estimates of the fracture-formation properties. For finite conductivity fractures, the stress effects in the formation have a negligible influence on the absolute value of the slope that defines the pseudo-bilinear flow regime. During this flow regime only the pressure sensitivity in the fracture and the fracture conductivity govern this flow period. For cases that involve highly conductive fractures, it was found that the slope of 0.5 which defines the linear flow regime is not influenced by the stress effect of the fracture and formation. However, stress in highly conductive fractures has a measurable influence in the change of conductivity. The occurrence of the stress damage in finite and infinite conductivity fractures is due to the partial closure fracture or partial choke fracture effect and can be anticipated in terms of pressure or time level by using the equations provided in this work. The results derived from this research have a major impact in improving the analysis of fractured wells pressure responses, as well as in forecasting of fracture closure occurrence and in programming stimulation operations in fractured wells. An example with synthetic data is presented to illustrate these new findings

  1. Subtrochanteric femur fracture after removal of screws for femoral neck fracture in a child. (United States)

    Song, Kwang Soon; Lee, Si Wook


    Displaced femoral neck fractures are rare in children and are associated with a high rate of complications. Subtrochanteric fractures after cannulated screw fixation of femoral neck fractures in adults are well recognized, and there are several reports on the topic. However, there are no reports on complications related to hardware or subtrochanteric fractures after removal of the screws in the treatment of femoral neck fractures in children. Here we report the case of a 10-year-old boy who sustained a subtrochanteric fracture after the screw removal and healing that followed a femoral neck fracture.

  2. Fractures in infants and toddlers with rickets

    Energy Technology Data Exchange (ETDEWEB)

    Chapman, Teresa; Done, Stephen [Seattle Children' s Hospital, Department of Radiology, Seattle, WA (United States); Sugar, Naomi; Feldman, Kenneth [Seattle Children' s Hospital, Children' s Protection Program, Seattle, WA (United States); Marasigan, Joanne; Wambold, Nicolle [University of Washington, College of Arts and Sciences, Seattle, WA (United States)


    Rickets affects young infants and toddlers. However, there is a paucity of literature regarding the types of fractures that occur in rachitic patients. To evaluate the age of patients at which radiographically evident rickets occurs, and to characterize the age incidence and fractures that are observed in infants and toddlers with radiographically evident rickets. A retrospective study of children younger than 24 months was performed. Clinical data and radiographs were reviewed. Radiographs obtained within 1 month of the diagnosis were evaluated for the presence or absence of osteopenia, presence or absence of fraying-cupping, and presence and characterization of fractures. After exclusion criteria were applied, 45 children were included in the study. Children with rickets evident by radiograph were in the age range of 2-24 months. Fractures were present in 17.5% of the study group, exclusively in mobile infants and toddlers. Fracture types included transverse long bone fractures, anterior and anterior-lateral rib fractures, and metaphyseal fractures. All fractures occurred exclusively in patients with severe, overtly evident rickets. Fractures occur in older infants and toddlers with overt rickets and can be seen by radiograph. Fractures do not resemble high-risk non-accidental trauma fractures. (orig.)


    African Journals Online (AJOL)


    which, comprise of at least 25% of all fractures in veterinary practice (Piermattei et al., 2006). Fracture of ... report the successful surgical management of unstable fracture of ilium and ischium of pelvis in a ... A similar principle was also applied ...

  4. Hydraulic fracturing with distinct element method

    NARCIS (Netherlands)

    Pruiksma, J.P.; Bezuijen, A.


    In this report, hydraulic fracturing is investigated using the distinct element code PFC2D from Itasca. Special routines were written to be able to model hydraulic fracturing. These include adding fluid flow to PFC2D and updating the fluid flow domains when fractures appear. A brief description of t

  5. Locking plates in proximal humerus fractures. (United States)

    Strohm, P C; Helwig, P; Konrad, G; Südkamp, N P


    It is well known that proximal humerus fractures are among the three most frequent fracture types. Epidemiological invetsigations show that in people elder than 60 years the fracture of the proximal humerus is more frequent than fractures of the hip region (17). Over the last decades several techniques have been applied for treatment of proximal humerus fractures. Widely accepted is the initiation of a conservative treatment regimen for undisplaced fractures, however, the standard treatment for displaced fractures, especially three and four part fractures, is still the center of scientific debate. Many different implants have been tested and investigated, thus demonstrating lack of sufficient results. Over the last years the development of angle stable, locking implants started and clinical studies demonstrated encouraging results. In our clinic the locking proximal humerus plate and the PHILOS plate advanced to the implant of choice for treatment of displaced proximal humerus fractures. There are still cases of implant failure and humerus head necrosis, but most of these complications were caused by the fracture type and not an implant specific problem. However the overall results with these new implants are encouraging. Key words: locking plates, proximal humerus fracture, humerus, humerus fracture, PHILOS, PHP.

  6. 49 CFR 195.111 - Fracture propagation. (United States)


    ... 49 Transportation 3 2010-10-01 2010-10-01 false Fracture propagation. 195.111 Section 195.111... PIPELINE Design Requirements § 195.111 Fracture propagation. A carbon dioxide pipeline system must be designed to mitigate the effects of fracture propagation....

  7. Functional outcome after a spinal fracture

    NARCIS (Netherlands)

    Post, Richard Bernardus


    This thesis takes a closer look at the functional outcome after a spinal fracture. An introduction to different aspects regarding spinal fractures is presented in Chapter 1. The incidence of traumatic thoracolumbar spinal fractures without neurological deficit in the Netherlands is approximately 1.2

  8. Facts and fiction in hip fracture treatment

    NARCIS (Netherlands)

    Embden, Daphne van


    As the number of hip fracture patients has increased dramatically over the years, the need for high quality, multidisciplinary and patient centred fracture treatment continues to grow. The first aim of this thesis is to provide better understanding of fracture patterns and classification in hip

  9. Lithium use and the risk of fractures

    NARCIS (Netherlands)

    Wilting, Ingeborg; de Vries, Frank; Thio, Brahm M. K. S.; Cooper, Cyrus; Heerdink, Eibert R.; Leutkens, Hubert G. M.; Nolen, Willem A.; Egberts, Antoine C. G.; van Staa, Tjeerd P.

    A recent study reported a decreased risk of fractures among lithium users. We conducted a case-control study within the UK General Practice Research Database, comparing never, ever, current, recent and past lithium use in 231,778 fracture cases to matched controls. In addition, the risk of fractures

  10. Functional outcome after a spinal fracture

    NARCIS (Netherlands)

    Post, Richard Bernardus


    This thesis takes a closer look at the functional outcome after a spinal fracture. An introduction to different aspects regarding spinal fractures is presented in Chapter 1. The incidence of traumatic thoracolumbar spinal fractures without neurological deficit in the Netherlands is approximately 1.2

  11. Periprosthetic acetabular fracture associated with extensive osteolysis. (United States)

    Chatoo, M; Parfitt, J; Pearse, M F


    Periprosthetic fracture of the acetabulum is an uncommon complication of total hip arthroplasty. The management is reported to be difficult, and complications such as nonunion and implant loosening are common. We described herein a case of nontraumatic periprosthetic acetabular fracture associated with significant osteolysis, which was successfully managed by addressing the fracture and osteolysis independently.

  12. Low-trauma fractures indicate increased risk of hip fracture in frail older people. (United States)

    Chen, Jian Sheng; Cameron, Ian D; Simpson, Judy M; Seibel, Markus J; March, Lyn M; Cumming, Robert G; Lord, Stephen R; Sambrook, Philip N


    This study aims to investigate the risk of subsequent fractures after low-trauma fracture in frail older people. A total of 1412 elderly residents (mean age 86.2 years, SD 7.0 years, female 77%) were recruited from aged care facilities in Australia. Residents were assessed and then followed for any fracture for 2 years and hip fractures for at least 5 years. Residents with and without a newly acquired fracture in the first 2 years were compared for risk of subsequent hip fracture. Residents with a nonhip fracture in the first 2 years had an increased risk of subsequent hip fracture for about 2.5 years, whereas those with a hip fracture had a similar risk over the whole period compared with those with no fracture. During these 2.5 years, 60, 28, and 6 subsequent hip fractures occurred in the nonfracture group (n = 953), the nonhip fracture group (n = 194), and the hip fracture group (n = 101), respectively, resulting in the probability of subsequent hip fracture of 8.0%, 19.9%, and 10.4%, respectively. Compared with the nonfracture group, the hazard ratio (HR) was 2.82 [95% confidence interval (CI) 1.73-4.59; p < .001] for the nonhip fracture group and 1.48 (95% CI 0.63-3.49, p = .37) for the hip fracture group after adjusting for age, sex, residence type, calcaneal broadband ultrasound attenuation, fracture history, weight, lower leg length, immobility, cognitive function, and medications. Frail institutionalized older people with newly acquired fractures are at increased risk of subsequent hip fracture for the next few years. Accordingly, despite their advanced age, they are a high-priority target group to investigate interventions that might reduce the risk of hip fracture.

  13. Subtrochanteric fractures in bisphosphonate-naive patients: results from the HORIZON-recurrent fracture trial. (United States)

    Adachi, Jonathan D; Lyles, Kenneth; Boonen, Steven; Colón-Emeric, Cathleen; Hyldstrup, Lars; Nordsletten, Lars; Pieper, Carl; Recknor, Chris; Su, Guoqin; Bucci-Rechtweg, Christina; Magaziner, Jay


    Our purpose was to characterize the risks of osteoporosis-related subtrochanteric fractures in bisphosphonate-naive individuals. Baseline characteristics of patients enrolled in the HORIZON-Recurrent Fracture Trial with a study-qualifying hip fracture were examined, comparing those who sustained incident subtrochanteric fractures with those sustaining other hip fractures. Subjects were bisphosphonate-naive or had a bisphosphonate washout period of 6-24 months and subsequently received an annual infusion of zoledronic acid 5 mg or placebo after low-trauma hip-fracture repair. In total, 2,127 men and women were included. Of the qualifying hip fractures, 5.2% were subtrochanteric, 54.8% femoral neck, 33.0% intertrochanteric, and 7.1% other (generally complex fractures of mixed type). Significant baseline (pre-hip fracture) differences were seen between index hip-fracture types, with the percentage of patients with extreme mobility problems being twofold higher in patients with index subtrochanteric fracture (9.9%) compared to other patients. The distribution of hip-fracture types was similar between the treatment groups at baseline. No patients with index subtrochanteric fractures and six patients with other qualifying hip fractures reported prior bisphosphonate use. Only one further subtrochanteric fracture occurred in each treatment group over an average 2-year patient follow-up. Subtrochanteric fractures are not uncommon in bisphosphonate-naive patients. Extreme difficulties with mobility may be a unique risk factor predisposing to development of incident subtrochanteric fractures rather than other types of hip fracture. In patients with recent hip fracture who received zoledronic acid therapy, the incidence of new subtrochanteric fractures was too small to draw any meaningful conclusions.

  14. Subtrochanteric Fractures in Bisphosphonate-Naive Patients: Results from the HORIZON-Recurrent Fracture Trial



    Our purpose was to characterize the risks of osteoporosis-related subtrochanteric fractures in bisphosphonate-naive individuals. Baseline characteristics of patients enrolled in the HORIZON-Recurrent Fracture Trial with a study-qualifying hip fracture were examined, comparing those who sustained incident subtrochanteric fractures with those sustaining other hip fractures. Subjects were bisphosphonate-naive or had a bisphosphonate washout period of 6–24 months and subsequently received an annu...

  15. Biomechanical Comparison of Two Kinds of Internal Fixation in a Type C Zone Ⅱ Pelvic Fracture Model

    Institute of Scientific and Technical Information of China (English)

    Tao Wu; Wei Chen; Qi Zhang; Zhan-Le Zheng; Hong-Zhi Lyu; Yun-Wei Cui; Xiao-Dong Cheng


    Background:Unstable pelvic fractures are complex and serious injuries.Selection of a fixation method for these fractures remains a challenging problem for orthopedic surgeons.This study aimed to compare the stability of Tile C pelvic fractures fixed with two iliosacral (IS) screws and minimally invasive adjustable plate (MIAP) combined with one IS screw.Methods:This study was a biomechanical experiment.Six embalmed specimens of the adult pelvis were used.The soft tissue was removed from the specimens,and the spines from the fourth lumbar vertebra to the proximal one-third of both femurs were retained.The pubic symphysis,bilateral sacroiliac joints and ligaments,bilateral hip joints,bilateral sacrotuberous ligaments,and bilateral sacrospinous ligaments were intact.Tile C pelvic fractures were made on the specimens.The symphysis pubis was fixed with a plate,and the fracture on the posterior pelvic ring was fixed with two kinds of internal fixation in turn.The specimens were placed in a biomechanical machine at a standing neutral posture.A cyclic vertical load of up to 500 N was applied,and displacement was recorded.Shifts in the fracture gap were measured by a grating displacement sensor.Statistical analysis used:Paired-samples t-test.Results:Under the vertical load of 100,200,300,400,and 500 N,the average displacement of the specimens fixed with MIAP combined with one IS screw was 0.46,0.735,1.377,1.823,and 2.215 mm,respectively,which was significantly lower than that of specimens fixed with two IS screws under corresponding load (P < 0.05).Under the vertical load of 500 N,the shift in the fracture gap of specimens fixed with MIAP combined with one IS screw was 0.261 ± 0.095 mm,and that of specimens fixed with two IS screws was 0.809 ± 0.170 mm.The difference was significant (P < 0.05).Conclusion:The stability of Tile C pelvic fractures fixed with MIAP combined with one IS screw was better than that fixed with two IS screws.

  16. Hydraulic fracturing system and method

    Energy Technology Data Exchange (ETDEWEB)

    Ciezobka, Jordan; Salehi, Iraj


    A hydraulic fracturing system and method for enhancing effective permeability of earth formations to increase hydrocarbon production, enhance operation efficiency by reducing fluid entry friction due to tortuosity and perforation, and to open perforations that are either unopened or not effective using traditional techniques, by varying a pump rate and/or a flow rate to a wellbore.

  17. Bone fractures: assessment and management. (United States)

    Lim, L; Sirichai, P


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

  18. Flexible fixation and fracture healing

    DEFF Research Database (Denmark)

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


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

  19. Sport-related maxillofacial fractures

    NARCIS (Netherlands)

    Ruslin, M.; Boffano, P.; ten Brincke, Y.J.D.; Forouzanfar, T.; Brand, H.S.


    Sports and exercise are important causes of maxillofacial injuries. Different types of sports might differ in frequency and type of fractures. The aim of the present study was to explore the possible relation between the types of sport practiced and the frequency and nature of the facial bone fractu

  20. Social inequality and hip fracture

    DEFF Research Database (Denmark)

    Harvey, N. C.; Hansen, L.; Judge, A.


    Social inequality appears to be increasing in many countries. We explored whether risk of hip fracture was associated with markers of inequality and whether these relationships changed with time, using data from Danish Health Registries. Methods: All patients 60 years or older with a primary hip...

  1. Sport-related maxillofacial fractures

    NARCIS (Netherlands)

    Ruslin, M.; Boffano, P.; ten Brincke, Y.J.D.; Forouzanfar, T.; Brand, H.S.


    Sports and exercise are important causes of maxillofacial injuries. Different types of sports might differ in frequency and type of fractures. The aim of the present study was to explore the possible relation between the types of sport practiced and the frequency and nature of the facial bone

  2. Hoffa fracture associated with ipsilateral femoral shaft fracture: clinical feature and treatment. (United States)

    Gong, Yu-Bao; Li, Qing-Song; Yang, Chen; Li, Shu-Qiang; Liu, Jian-Guo; Qi, Xin


    Hoffa fracture associated with ipsilateral femoral shaft fracture is very rare. Three cases of this rare type of injury were retrospectively reviewed. The sites of femoral shaft fractures and Hoffa fractures were documented. All femoral shaft fractures were managed with internal fixation. The rate of misdiagnosis for the Hoffa fractures was documented. Functions of the affected knees were evaluated according to the modified Hospital for Special Surgery (HSS) scores at two years follow-up. Femoral fractures were either transverse or composite in all three cases. Ipsilateral Hoffa fractures occurred at medial condyle in two cases, and lateral condyle in one case. Only one Hoffa fracture was identified preoperatively. All the femoral shaft fractures healed uneventfully. In the patient whose Hoffa fracture was correctly diagnosed, the modified HSS score was 94. In another patient, whose Hoffa fracture was treated by a second operation, the modified HSS score was 93. And in the third case, who refused additional operation for the Hoffa fracture, the modified HSS score was only 70. Conclusively femoral shaft fracture can be associated with ipsilateral Hoffa fracture, especially in motorcycle accident. This type of injury is very rare and misdiagnosis is common.

  3. Hoffa fracture associated with ipsilateral femoral shaft fracture: clinical feature and treatment

    Institute of Scientific and Technical Information of China (English)

    GONG Yu-bao; LI Qing-song; YANG Chen; LI Shu-qiang; LIU Jian-guo; QI Xin


    Hoffa fracture associated with ipsilateral femoral shaft fracture is very rare.Three cases of this rare type of injury were retrospectively reviewed.The sites of femoral shaft fractures and Hoffa fractures were documented.All femoral shaft fractures were managed with internal fixation.The rate of misdiagnosis for the Hoffa fractures was documented.Functions of the affected knees were evaluated according to the modified Hospital for Special Surgery (HSS) scores at two years follow-up.Femoral fractures were either transverse or composite in all three cases.Ipsilateral Hoffa fractures occurred at medial condyle in two cases,and lateral condyle in one case.Only one Hoffa fracture was identified preoperatively.All the femoral shaft fractures healed uneventfully.In the patient whose Hoffa fracture was correctly diagnosed,the modified HSS score was 94.In another patient,whose Hoffa fracture was treated by a second operation,the modified HSS score was 93.And in the third case,who refused additional operation for the Hoffa fracture,the modified HSS score was only 70.Conclusively femoral shaft fracture can be associated with ipsilateral Hoffa fracture,especially in motorcycle accident.This type of injury is very rare and misdiagnosis is common.

  4. Analysis of Fracturing Network Evolution Behaviors in Random Naturally Fractured Rock Blocks (United States)

    Wang, Y.; Li, X.; Zhang, B.


    Shale gas has been discovered in the Upper Triassic Yanchang Formation, Ordos Basin, China. Due to the weak tectonic activities in the shale plays, core observations indicate abundant random non-tectonic micro-fractures in the producing shales. The role of micro-fractures in hydraulic fracturing for shale gas development is currently poorly understood yet potentially critical. In a series of scaled true triaxial laboratory experiments, we investigate the interaction of propagating fracturing network with natural fractures. The influence of dominating factors was studied and analyzed, with an emphasis on non-tectonic fracture density, injection rate, and stress ratio. A new index of P-SRV is proposed to evaluate the fracturing effectiveness. From the test results, three types of fracturing network geometry of radial random net-fractures, partly vertical fracture with random branches, and vertical main fracture with multiple branches were observed. It is suggested from qualitative and quantitative analysis that great micro-fracture density and injection rate tend to maximum the fracturing network; however, it tends to decrease the fracturing network with the increase in horizontal stress ratio. The function fitting results further proved that the injection rate has the most obvious influence on fracturing effectiveness.

  5. Economic burden of osteoporosis-related hip fracture in Asia: a systematic review. (United States)

    Mohd-Tahir, N-A; Li, S-C


    This review analyzes the economic costs of HF in Asia. The availability and quality of studies on the burden of osteoporosis in Asia are very scarce. There is a need to encourage more quality cost of osteoporosis studies based on standardized methods to convince healthcare authorities in implementing appropriate strategies. Osteoporosis fractures, especially hip fractures, impose large economic costs to governments and societies. This review aimed to systematically analyze available evidence on healthcare costs associated with osteoporosis-related hip fractures (HF) in Asia. Articles were systematically sought from databases including PubMed, EMBASE, and EBSCOHost between 2000 and 2015. Total costs associated with HF care, the cost components, and length of stays were retrieved and analyzed. Study designs were also qualitatively analyzed. The availability of published studies on economic burden of HF in Asia is severely lacking with only 15 articles met the inclusion criteria. Even among the included studies, only two studies reported comprehensive costs evaluating all costs including indirect or intangible costs. Most studies satisfactorily reported criteria for conducting economic evaluation, but large variations existed in the methodological design. Due to study design and other influencing factors, large variation in the cost of HF treatment from US$774 to US$14,198.90 (median S$2943), representing an average of 18.95% (range: 3.58-57.05%) of the countries' 2014 GDP/capita, was observed. This highlighted the heavy burden of managing HF in Asia with about 40% of the included studies reported using more than one third of GDP/capita. There is a paucity of burden of illness studies of osteoporosis in the Asian region. For the few available studies, there was a lack of standardization in methodological approach in evaluating the economic burden of the disease. There is a need to encourage more quality burden of illness studies of osteoporosis to inform policymakers

  6. Rib Fracture Diagnosis in the Panscan Era. (United States)

    Murphy, Charles E; Raja, Ali S; Baumann, Brigitte M; Medak, Anthony J; Langdorf, Mark I; Nishijima, Daniel K; Hendey, Gregory W; Mower, William R; Rodriguez, Robert M


    With increased use of chest computed tomography (CT) in trauma evaluation, traditional teachings in regard to rib fracture morbidity and mortality may no longer be accurate. We seek to determine rates of rib fracture observed on chest CT only; admission and mortality of patients with isolated rib fractures, rib fractures observed on CT only, and first or second rib fractures; and first or second rib fracture-associated great vessel injury. We conducted a planned secondary analysis of 2 prospectively enrolled cohorts of the National Emergency X-Radiography Utilization Study chest studies, which evaluated patients with blunt trauma who were older than 14 years and received chest imaging in the emergency department. We defined rib fractures and other thoracic injuries according to CT reports and followed patients through their hospital course to determine outcomes. Of 8,661 patients who had both chest radiograph and chest CT, 2,071 (23.9%) had rib fractures, and rib fractures were observed on chest CT only in 1,368 cases (66.1%). Rib fracture patients had higher admission rates (88.7% versus 45.8%; mean difference 42.9%; 95% confidence interval [CI] 41.4% to 44.4%) and mortality (5.6% versus 2.7%; mean difference 2.9%; 95% CI 1.8% to 4.0%) than patients without rib fracture. The mortality of patients with rib fracture observed on chest CT only was not statistically significantly different from that of patients with fractures also observed on chest radiograph (4.8% versus 5.7%; mean difference -0.9%; 95% CI -3.1% to 1.1%). Patients with first or second rib fractures had significantly higher mortality (7.4% versus 4.1%; mean difference 3.3%; 95% CI 0.2% to 7.1%) and prevalence of concomitant great vessel injury (2.8% versus 0.6%; mean difference 2.2%; 95% CI 0.6% to 4.9%) than patients with fractures of ribs 3 to 12, and the odds ratio of great vessel injury with first or second rib fracture was 4.4 (95% CI 1.8 to 10.4). Under trauma imaging protocols that commonly


    Energy Technology Data Exchange (ETDEWEB)

    Lam, P; Prof. Yuh J. Chao, P


    The meaning of the phrase 'constraint effect in fracture' has changed in the past two decades from 'contained plasticity' to a broader description of 'dependence of fracture toughness value on geometry of test specimen or structure'. This paper will first elucidate the fundamental mechanics reasons for the apparent 'constraint effects in fracture', followed by outlining a straightforward approach to overcoming this problem in both brittle (elastic) and ductile (elastic-plastic) fracture. It is concluded by discussing the major difference in constraint effect on fracture event in elastic and elastic-plastic materials.

  8. Geomechanical Simulation of Fluid-Driven Fractures

    Energy Technology Data Exchange (ETDEWEB)

    Makhnenko, R.; Nikolskiy, D.; Mogilevskaya, S.; Labuz, J.


    The project supported graduate students working on experimental and numerical modeling of rock fracture, with the following objectives: (a) perform laboratory testing of fluid-saturated rock; (b) develop predictive models for simulation of fracture; and (c) establish educational frameworks for geologic sequestration issues related to rock fracture. These objectives were achieved through (i) using a novel apparatus to produce faulting in a fluid-saturated rock; (ii) modeling fracture with a boundary element method; and (iii) developing curricula for training geoengineers in experimental mechanics, numerical modeling of fracture, and poroelasticity.

  9. Bisphosphonate-associated atypical subtrochanteric femur fracture. (United States)

    Wolin, Ely A; Banks, Kevin P; Vroman, Penny J


    Bisphosphonates help prevent progressive bone mineralization loss and subsequent osteoporotic fractures. However, long-term bisphosphonate therapy paradoxically increases the risk of a unique injury called an atypical subtrochanteric femur fracture. Despite this, the benefits of bisphosphonates outweigh the risks, because far more pathologic fractures are prevented than induced. The early identification of atypical subtrochanteric femur fractures is important as there is high associated morbidity and mortality. We describe a case of a 76-y-old woman with a completed bisphosphonate-associated atypical subtrochanteric femur fracture.

  10. Pulsative hematoma: A penile fracture complication

    Directory of Open Access Journals (Sweden)

    Nale Đorđe


    Full Text Available Background. Fracture of the penis is a direct blunt trauma of the erect or semi-erect penis. It can be treated by conservative or surgical means. Retrospective analyses of conservative penile fracture treatment reveal frequent immediate and later complications. Case report. We presented a 41- year-old patient with pulsative hematoma caused by an unusual fracture of the penis. Fracture had appeared 40 days before the admittance during a sexual intercourse. The patient was treated surgically. Conclusion. Pulsative hematoma (pulsative diverticulum is a very rare, early complication of a conservatively treated penile fracture. Surgical treatment has an advantage over surgical one, which was confirmed by our case report.

  11. Effects of fracture reactivation and diagenesis on fracture network evolution: Cambrian Eriboll Formation, NW Scotland (United States)

    Hooker, J. N.; Eichhubl, P.; Xu, G.; Ahn, H.; Fall, A.; Hargrove, P.; Laubach, S.; Ukar, E.


    The Cambrian Eriboll Formation quartzarenites contain abundant fractures with varying degrees of quartz cement infill. Fractures exist that are entirely sealed; are locally sealed by bridging cements but preserve pore space among bridges; are mostly open but lined with veneers of cement; or are devoid of cement. Fracture propagation in the Eriboll Formation is highly sensitive to the presence of pre-existing fractures. Fracture reactivation occurs in opening mode as individual fractures repeatedly open and are filled or bridged by syn-kinematic cements. As well, reactivation occurs in shear as opening of one fracture orientation coincides with shear displacement along pre-existing fractures of different orientations. The tendency for pre-existing fractures to slip varies in part by the extent of cement infill, yet we observe shear and opening-mode reactivation even among sealed fractures. Paleotemperature analysis of fluid inclusions within fracture cements suggests some fractures now in outcrop formed deep in the subsurface. Fractures within the Eriboll Formation may therefore affect later fracture propagation throughout geologic time. With progressive strain, fault zones develop within fracture networks by a sequence of opening-mode fracture formation, fracture reactivation and linkage, fragmentation, cataclasis, and the formation of slip surfaces. Cataclasite within fault zones is commonly more thoroughly cemented than fractures in the damage zone or outside the fault zone. This variance of cement abundance is likely the result of (1) continued exposure of freshly broken quartz surfaces within cataclasite, promoting quartz precipitation, and (2) possibly more interconnected pathways for mass transfer within the fault zone. Enhanced cementation of cataclasite results in strengthening or diagenetic strain hardening of the evolving fault zone. Further slip is accommodated by shear localization along discrete slip surfaces. With further linkage of fault segments

  12. Modeling fracture porosity evolution in dolostone (United States)

    Gale, Julia F. W.; Lander, Robert H.; Reed, Robert M.; Laubach, Stephen E.


    Opening-mode fractures in dolostones buried to depths of ˜1-5 km contain synkinematic dolomite cement, the amount and internal structure of which has a systematic relationship to fracture size. Narrow fractures (cement or cement with a crack-seal texture that indicates multiple incremental openings. Wider fractures can preserve considerable effective porosity, but anomalously thick dolomite cement bridges are commonly present in fractures that are otherwise lined with a thin veneer of cement. Dolomite bridges resemble quartz bridges that are common in fractured sandstones. We developed a geometric crystal growth model for synkinematic dolomite fracture fill in fractured dolostones, where periodic incremental fracture-opening events are introduced with concurrent cement growth. We assumed constant temperature and supersaturation with respect to dolomite. A key assumption in the model is that rapid dolomite accumulation within bridges is governed by high cement-growth rates on repeatedly broken grain surfaces during the process of crack seal. Slower cement-growth rates occur on euhedral crystals. This assumption is made on the basis of a comparison with quartz cement growth in fractured sandstones. Simulations with different fracture-opening rates mimic bridge and lining cement morphologies, including characteristic rhombic shapes of dolomite bridges.

  13. Temporal bone fracture and its complications

    Institute of Scientific and Technical Information of China (English)


    Objective: To explore the characteristics and treatment oftemporal bone fractures and injuries in the medial-inner ear.Methods: The clinical data of 48 cases of temporal bone fractures admitted to our hospital from January 1989 to November 1999 were retrospectively analyzed.Results: Forty-eight patients with temporal bone fractures accounted for 17.00% of the homochronous craniofacial fractures. Of the 48 cases, temporal bone fractures induced by traffic accidents accounted for 66.67%, capillary fractures for 93.75%, medial-inner ear injuries or craniocerebral injuries for 77.08% and hearing loss or tinnitus for 48.00%. The cerebrospinal fluid (CSF) otorrhea and facioplegia accounted for 36.70% and 3.00%, respectively, in the longitudinal fractures, while they were 25.00% and 37.50%, respectively, in the transversal fractures. Primary emergent operations were performed on 46 cases and neurosurgery accounted for 46.00%. Secondary procedures accounted for 16.70%. As a result, 43 cases survived (89.58%) and 5 died (10.41%).Conclusions: Traffic injury is the first high-dangerous factor for temporal bone fractures, which are often complicated with medial-inner ear or craniocerebral injury. The CSF otorrhea is common in the longitudinal fractures and facioplegia is common in the transversal fractures. The key step is to rescue the life, keep the airway unobstructed and maintain the circulation in the primary emergency treatment.


    Energy Technology Data Exchange (ETDEWEB)

    Abbas Firoozabadi


    Numerical simulation of water injection in discrete fractured media with capillary pressure is a challenge. Dual-porosity models in view of their strength and simplicity can be mainly used for sugar-cube representation of fractured media. In such a representation, the transfer function between the fracture and the matrix block can be readily calculated for water-wet media. For a mixed-wet system, the evaluation of the transfer function becomes complicated due to the effect of gravity. In this work, they use a discrete-fracture model in which the fractures are discretized as one dimensional entities to account for fracture thickness by an integral form of the flow equations. This simple step greatly improves the numerical solution. Then the discrete-fracture model is implemented using a Galerkin finite element method. The robustness and the accuracy of the approach are shown through several examples. First they consider a single fracture in a rock matrix and compare the results of the discrete-fracture model with a single-porosity model. Then, they use the discrete-fracture model in more complex configurations. Numerical simulations are carried out in water-wet media as well as in mixed-wet media to study the effect of matrix and fracture capillary pressures.

  15. Isolated Fracture of the Coracoid Process

    Directory of Open Access Journals (Sweden)

    Ali Güleç


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

  16. Clavicle fractures - incidence of supraclavicular nerve injury

    Directory of Open Access Journals (Sweden)

    Pedro Jose Labronici


    Full Text Available OBJECTIVE: To analyze retrospectively 309 fractures in the clavicle and the relation with injury of the supraclavicular nerve after trauma. METHODS: It was analyzed 309 patients with 312 clavicle fractures. The Edinburgh classification was used. Four patients had fractures in the medial aspect of the clavicle, 33 in the lateral aspect and 272 in the diaphyseal aspect and three bilateral fractures. RESULTS: 255 patients were analyzed and five had paresthesia in the anterior aspect of the thorax. Four patients had type 2 B2 fracture and one type 2 B1 fracture. All patients showed spontaneous improvement, in the mean average of 3 months after the trauma. CONCLUSION: Clavicle fractures and/ or shoulder surgeries can injure the lateral, intermediary or medial branches of the supraclavicular nerve and cause alteration of sensibility in the anterior aspect of the thorax. Knowledge of the anatomy of the nerve branches helps avoid problems in this region.


    Directory of Open Access Journals (Sweden)

    Gde Rastu Adi Mahartha


    Full Text Available Fracture is a loss of continuity of bone, either total or partial, is usually caused by trauma. Overall incidence of fractures was 11.3 in 1,000 per year, in males was 11.67 in 1000 per year, whereas in 10.65 in 1,000 women per year. The classic symptom is a history of trauma fracture, pain and swelling in the broken bones, deformity, musculoskeletal dysfunction, breaking the continuity of the bone, and neurovascular disorders. Principles of fracture treatment is to restore the position of the fracture to its original position (reposition and held that position during the healing of fractures (immobilization. Special in open fractures, must be considered the danger of infection, either general or local infection.

  18. Osteoporotic fractures: a brain or bone disease? (United States)

    Birge, Stanley J


    Osteoporosis is a skeletal disorder that predisposes individuals to increased risk of fracture. However, most osteoporotic fractures occur in women who do not meet criteria for osteoporosis. Hence, bone density, by itself, is a relatively poor predictor of fracture. Age and age-related factors are now recognized as increasingly important in determining fracture risk. Osteoporotic fractures are associated with increased disability and mortality, suggesting that osteoporosis may be a clinical manifestation of an underlying disease process affecting multiple systems. The systems affected, the musculo-skeletal system and the central nervous system, are shared in many respects with the frailty syndrome. Vitamin D deficiency is a major contributor to the frailty syndrome, osteoporosis, and osteoporotic fractures. Its effects are mediated by the development of cerebrovascular disease, postural instability, muscle weakness, and bone fragility. Thus, osteoporotic fractures result from both a bone and brain disease.

  19. Incidence and epidemiology of tibial shaft fractures

    DEFF Research Database (Denmark)

    Larsen, Peter; Elsøe, Rasmus; Hansen, Sandra Hope


    Introduction: The literature lacks recent population-based epidemiology studies of the incidence, trauma mechanism and fracture classification of tibial shaft fractures. The purpose of this study was to provide up-to-date information on the incidence of tibial shaft fractures in a large...... and complete population and report the distribution of fracture classification, trauma mechanism and patient baseline demographics. Methods: Retrospective reviews of clinical and radiological records. Results: A total of 196 patients were treated for 198 tibial shaft fractures in the years 2009 and 2010....... The mean age at time of fracture was 38.5 (21.2SD) years. The incidence of tibial shaft fracture was 16.9/100,000/year. Males have the highest incidence of 21.5/100,000/year and present with the highest frequency between the age of 10 and 20, whereas women have a frequency of 12.3/100,000/year and have...

  20. Mixed-mode fracture of ceramics

    Energy Technology Data Exchange (ETDEWEB)

    Petrovic, J.J.


    The mixed-mode fracture behavior of ceramic materials is of importance for monolithic ceramics in order to predict the onset of fracture under generalized loading conditions and for ceramic composites to describe crack deflection toughening mechanisms. Experimental data on surface flaw mixed-mode fracture in various ceramics indicate that the flaw-plane normal stress at fracture decreases with increasing in-flaw-plane shear stress, although present data exhibit a fairly wide range in details of this sigma - tau relationship. Fracture from large cracks suggests that Mode II has a greater effect on Mode I fracture than Mode III. A comparison of surface flaw and large crack mixed-mode I-II fracture responses indicated that surface flaw behavior is influenced by shear resistance effects.

  1. Natural thermal convection in fractured porous media (United States)

    Adler, P. M.; Mezon, C.; Mourzenko, V.; Thovert, J. F.; Antoine, R.; Finizola, A.


    In the crust, fractures/faults can provide preferential pathways for fluid flow or act as barriers preventing the flow across these structures. In hydrothermal systems (usually found in fractured rock masses), these discontinuities may play a critical role at various scales, controlling fluid flows and heat transfer. The thermal convection is numerically computed in 3D fluid satured fractured porous media. Fractures are inserted as discrete objects, randomly distributed over a damaged volume, which is a fraction of the total volume. The fluid is assumed to satisfy Darcy's law in the fractures and in the porous medium with exchanges between them. All simulations were made for Rayleigh numbers (Ra) equilibrium with the medium), cubic boxes and closed-top conditions. Checks were performed on an unfractured porous medium and the convection cells do start for the theoretical value of Ra, namely 4p². 2D convection was verified up to Ra=800. The influence of parameters such as fracture aperture (or fracture transmissivity), fracture density and fracture length is studied. Moreover, these models are compared to porous media with the same macroscopic permeability. Preliminary results show that the non-uniqueness associated with initial conditions which makes possible either 2D or 3D convection in porous media (Schubert & Straus 1979) is no longer true for fractured porous media (at least for 50fracture density and fracture aperture on the Nusselt number (Nu) is highly Ra dependent. The effect of the damaged zone on Nu is roughly proportional to its size. All these models also allows us to determine for which range of fracture density the fractured porous medium is in good agreement with an unfractured porous medium of the same bulk permeability.

  2. Vertebral Geometry Parameters Can Predict Fractures

    Directory of Open Access Journals (Sweden)

    P Tofighi


    Full Text Available Background: The aim of this study was to investigate vertebral geometry changes and determine cutoff value of vertebral height to predict fractures. Methods: In a cross-sectional study, 280 postmenopausal women recruited .In all subjects bone mineral density and radiog¬raphy of the lumbar spine performed. Lateral radiographs were evaluated for identification of vertebral fractures, using a validated semiquantitative method. T-score of vertebral height was calculated based on data extracted from Iranian Multi¬center Osteoporosis Study. ROC curve used to determine cut off value of vertebral height T-score to predict fractures. Results: The mean of age and BMI were 55.34±8.7 years and 27.73±5 kg/m2, respectively. Among osteoporotic women, 59.8% had one or more vertebral fractures and 23.8% had at least 2 fractures. In fracture group the T-score of spine and femur BMD was lower than the others. The mean of vertebral height in women without fractures was 12.94±0.6 cm, and in the patient with 4 or more fractures was12.3, thus every fracture accompany with 1.2% decreases in the height of vertebrae. The prevalence of vertebral fracture in osteoporotic patients was 71.4% and in healthy cases 39.5%. Better estimation of vertebral height T score in ROC curve was less than -0.7.The sensitivity and specificity of the cut off value were 81.3% and 52.9%, respectively. Conclusion: Vertebral fractures are common fractures in postmenopausal women. There was a correlation between verte¬bral height and fractures. Vertebral geometric parameters especially height T score can be used for fracture screening.

  3. Hydraulic fracturing model based on the discrete fracture model and the generalized J integral (United States)

    Liu, Z. Q.; Liu, Z. F.; Wang, X. H.; Zeng, B.


    The hydraulic fracturing technique is an effective stimulation for low permeability reservoirs. In fracturing models, one key point is to accurately calculate the flux across the fracture surface and the stress intensity factor. To achieve high precision, the discrete fracture model is recommended to calculate the flux. Using the generalized J integral, the present work obtains an accurate simulation of the stress intensity factor. Based on the above factors, an alternative hydraulic fracturing model is presented. Examples are included to demonstrate the reliability of the proposed model and its ability to model the fracture propagation. Subsequently, the model is used to describe the relationship between the geometry of the fracture and the fracturing equipment parameters. The numerical results indicate that the working pressure and the pump power will significantly influence the fracturing process.

  4. An Unusual Combination of Acetabular and Pelvic Fracture: Is This a New Subtype of Acetabular Fracture?

    Directory of Open Access Journals (Sweden)

    Reza Tavakoli Darestani


    Full Text Available Introduction: Acetabular fractures are a common problem among young males. An acetabular fracture with disruption of the joint surface, if untreated, will rapidly lead to post-traumatic osteoarthritis. Proper reduction and internal fixation depend on accurate classification and the quality of imaging.Case Presentation: We present an unusual form of acetabular fracture, which is not included in the conventional classification (Judet and Letournel ; this occurred in a middle-aged male who was operatively treated without any complications. In this case due to posterior extension of the fracture into the SI joint and concomitant anterior column fracture in the area above the acetabular dome, no portion of the acetabular anterior surface remained connected to the innominate bone.Conclusions: We recognized this type of fracture and treated it similarly to both column fractures. We recommend that the classification of acetabular fractures be modified to include this type of fracture.

  5. Discrete fracture modeling of multiphase flow and hydrocarbon production in fractured shale or low permeability reservoirs (United States)

    Hao, Y.; Settgast, R. R.; Fu, P.; Tompson, A. F. B.; Morris, J.; Ryerson, F. J.


    It has long been recognized that multiphase flow and transport in fractured porous media is very important for various subsurface applications. Hydrocarbon fluid flow and production from hydraulically fractured shale reservoirs is an important and complicated example of multiphase flow in fractured formations. The combination of horizontal drilling and hydraulic fracturing is able to create extensive fracture networks in low permeability shale rocks, leading to increased formation permeability and enhanced hydrocarbon production. However, unconventional wells experience a much faster production decline than conventional hydrocarbon recovery. Maintaining sustainable and economically viable shale gas/oil production requires additional wells and re-fracturing. Excessive fracturing fluid loss during hydraulic fracturing operations may also drive up operation costs and raise potential environmental concerns. Understanding and modeling processes that contribute to decreasing productivity and fracturing fluid loss represent a critical component for unconventional hydrocarbon recovery analysis. Towards this effort we develop a discrete fracture model (DFM) in GEOS (LLNL multi-physics computational code) to simulate multiphase flow and transfer in hydraulically fractured reservoirs. The DFM model is able to explicitly account for both individual fractures and their surrounding rocks, therefore allowing for an accurate prediction of impacts of fracture-matrix interactions on hydrocarbon production. We apply the DFM model to simulate three-phase (water, oil, and gas) flow behaviors in fractured shale rocks as a result of different hydraulic stimulation scenarios. Numerical results show that multiphase flow behaviors at the fracture-matrix interface play a major role in controlling both hydrocarbon production and fracturing fluid recovery rates. The DFM model developed in this study will be coupled with the existing hydro-fracture model to provide a fully integrated

  6. [Investigate progress of intraoperative periprosthetic fracture of total hip arthroplasty]. (United States)

    Cong, Yu; Zhao, Jian-ning


    One of the complications of total hip arthroplasty is intraoperative periprosthetic fracture. Periprosthetic fracture is divided into acetabular fracture and femoral fracture. Risk factors for intraoperative periprosthetic fracture include use of minimally invasive techniques, press-fit cementless stems, revision operations and osteoporosis. It has been recognized that treatment of intraoperative periprosthetic fractures should be based on the classification of the Vancouver system for intraoperative fractures.

  7. Buttress plating for a rare case of comminuted medial condylar Hoffa fracture associated with patellar fracture

    Institute of Scientific and Technical Information of China (English)

    Ashwani Soni; Ramesh K Sen; Uttam Chand Saini; Dajjit Singh; Sushil Chaudhary


    Hoffa fracture is an uncommon injury.In the literature,lateral condylar Hoffa fracture is mentioned as a more common injury pattern than medial condylar Hoffa fracture.The mechanism of injury and method of treatment is not very well described in the literature.We are presenting a rare case of comminuted medial condylar Hoffa fracture with ipsitateral patellar fracture.The mechanism of injury has not been described in the literature.Lag screw fixation,which is the most acceptable method of treatment,is not possible due to comminution.We explain the possible mechanism of injury and fix the fracture with L-buttress plate.

  8. The healing of fractured bones

    Energy Technology Data Exchange (ETDEWEB)

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


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

  9. Our Results in Penile Fractures

    Directory of Open Access Journals (Sweden)

    Tufan Süelözgen


    Full Text Available Introduction Penile fracture is a urological emergency caused by direct trauma to an erected penis, tearing the tunica albuginea in the corpus cavernosum. The preferred treatment method is draining the hematoma and surgical repair of tunica albuginea tear as soon as possible following diagnosis. Materials and Methods Forty-nine patients who were diagnosed with penile fracture between January 2009 and December 2014 were reviewed. Physical examination was performed to see the extent of penile hematoma, the side of the penile curvature and the presence of blood in the external meatus. Two patients who were diagnosed with urethrorrhagia underwent retrograde urethrogram for urethral injury. In all patients, penile skin was peeled using a circular subcoronal degloving incision and tunica tear was repaired using absorbable suture materials. The patients were then followed for painful erections, penile deformities and erection angles. Results The average age of the 49 patients, who were included in the study, was 36.5 years (21-65. In their etiological questioning, most patients reported the fracture occurring during sexual intercourse. Retrograde urethrography was indicated in 2 patients with blood in the external meatus and were diagnosed with urethral injury. The patients were taken to emergency surgery. Tunica defects varied between 1 and 2 cm. Incomplete urethral injuries were primarily repaired around 18 French Foley catheter. None of the patients reported penile deformity or painful erections. Their erection angles were found to be within the normal range. Conclusion Even though it is a relatively rare condition, penile fractures are so important that might cause serious complications when not treated surgically. A thorough anamnesis and physical examination suffice for diagnosis.

  10. Well test analysis in fractured media

    Energy Technology Data Exchange (ETDEWEB)

    Karasaki, K.


    The behavior of fracture systems under well test conditions and methods for analyzing well test data from fractured media are investigated. Several analytical models are developed to be used for analyzing well test data from fractured media. Numerical tools that may be used to simulate fluid flow in fractured media are also presented. Three types of composite models for constant flux tests are investigated. These models are based on the assumption that a fracture system under well test conditions may be represented by two concentric regions, one representing a small number of fractures that dominates flow near the well, and the other representing average conditions farther away from the well. Type curves are presented that can be used to find the flow parameters of these two regions and the extent of the inner concentric region. Several slug test models with different geometric conditions that may be present in fractured media are also investigated. A finite element model that can simulate transient fluid flow in fracture networks is used to study the behavior of various two-dimensional fracture systems under well test conditions. A mesh generator that can be used to model mass and heat flow in a fractured-porous media is presented.

  11. Natural fracture characterization using passive seismic illumination

    Energy Technology Data Exchange (ETDEWEB)

    Nihei, K.T.


    The presence of natural fractures in reservoir rock can significantly enhance gas production, especially in tight gas formations. Any general knowledge of the existence, location, orientation, spatial density, and connectivity of natural fractures, as well as general reservoir structure, that can be obtained prior to active seismic acquisition and drilling can be exploited to identify key areas for subsequent higher resolution active seismic imaging. Current practices for estimating fracture properties before the acquisition of surface seismic data are usually based on the assumed geology and tectonics of the region, and empirical or fracture mechanics-based relationships between stratigraphic curvature and fracturing. The objective of this research is to investigate the potential of multicomponent surface sensor arrays, and passive seismic sources in the form of local earthquakes to identify and characterize potential fractured gas reservoirs located near seismically active regions. To assess the feasibility of passive seismic fracture detection and characterization, we have developed numerical codes for modeling elastic wave propagation in reservoir structures containing multiple, finite-length fractures. This article describes our efforts to determine the conditions for favorable excitation of fracture converted waves, and to develop an imaging method that can be used to locate and characterize fractures using multicomponent, passive seismic data recorded on a surface array.

  12. Tibia and fibula fractures in soccer players. (United States)

    Boden, B P; Lohnes, J H; Nunley, J A; Garrett, W E


    We performed a retrospective review of 31 athletes who sustained a fracture of the lower leg from a direct blow while playing soccer. Fifteen fractures involved both the tibia and fibula 11 only the tibia, and 5 only the fibula. Information was collected using a standardized questionnaire. The mean follow-up from the time of injury was 30 months. Injuries typically occurred in young, competitive athletes during game situations. The mechanisms were broadly classified into several categories: contact during a slide tackle (13, 42%), a collision with the goalkeeper (8, 26%), two opposing players colliding while swinging for a loose ball (7, 23%), or a player being kicked by a standing opponent (3, 10%). The majority of fractures (26, 90%) occurred while the athletes were wearing shin guards. The point of impact was with the shin guard prior to the fracture in 16 cases (62%). Return to competitive soccer averaged 40 weeks for combined tibia and fibula fractures, 35 weeks for isolated tibia fractures, and 18 weeks for isolated fibula fractures. Injuries were associated with a high incidence of major complications (12 out of 31, 39%), especially in concurrent tibia and fibula fractures (8 out of 15, 50%). These findings suggest that lower leg fractures in soccer players are serious injuries, often necessitating a prolonged recovery time. In addition, this study questions the ability of shin guards to protect against fractures.

  13. Current concepts in pediatric femur fracture treatment. (United States)

    Kanlic, Enes; Cruz, Miguel


    Femoral neck fractures require urgent evacuation of intracapsular hematoma, anatomic reduction, and secure fixation with screws and cast immobilization. Extracapsular trochanteric and subtrochanteric fractures are best treated by fixed angle devices (locked plates or dynamic screw and side plate). "Length stable" low energy shaft fractures with minimal displacement or fractures are treated operatively. Transverse or short oblique shaft fractures in patients fractures. Children > 12 years have less risk of vascular disturbance to the proximal physis, and should have lateral transtrochanateric entry locked rigid nails. Fractures with severe soft tissue injuries could be temporized with external fixation. Distal physis and epiphyseal injuries require anatomical reduction and smooth wires and/or screw fixation (placed in such a way as to minimize further damage to the physis) and need to be augmented with a brace. Leg-length discrepancy is not a significant clinical problem in operatively treated patients. We recommend hardware removal after complete fracture healing, usually in 6 to 12 months. Implants left in the growing child could become buried deep inside of the bone, or cause "periprosthetic" fractures and/or eventually impede adult reconstruction. Minimal risks are reported for hardware removal in healthy patients with healed fractures (4 cortices bridged).

  14. Treatment algorithm of acetabular periprosthetic fractures. (United States)

    Simon, Paul; von Roth, Philipp; Perka, Carsten


    Periprosthetic fractures of the acetabulum represent a rare incident in primary and revision total hip arthroplasty. The management of these fractures can be challenging. At present, there are no reliable guidelines for the treatment of periprosthetic acetabular fractures. Periprosthetic acetabular fractures can occur intra-operatively, in particular during insertion of non-cemented cups or in the context of revision surgery. Post-operative causes for periprosthetic acetabular fractures are traumatic events or, more commonly, pelvic discontinuity due to severe bone loss related to osteolysis. Despite their aetiology, the main objective of surgery is to achieve a stable acetabular component and fracture. While stable fractures and implants could be treated non-operatively, unstable fractures require surgery to achieve component stability and allow appropriate biological fixation of the revision cup. Assessment of the stability plays a crucial role before determining the treatment strategy. There is a large variety of surgical techniques available for the management of these fractures. This review article outlines the epidemiology, aetiology and current classification systems, and provides a distinct diagnostic and therapeutic algorithm for the treatment of periprosthetic acetabular fractures.

  15. Economic viability of geriatric hip fracture centers. (United States)

    Clement, R Carter; Ahn, Jaimo; Mehta, Samir; Bernstein, Joseph


    Management of geriatric hip fractures in a protocol-driven center can improve outcomes and reduce costs. Nonetheless, this approach has not spread as broadly as the effectiveness data would imply. One possible explanation is that operating such a center is not perceived as financially worthwhile. To assess the economic viability of dedicated hip fracture centers, the authors built a financial model to estimate profit as a function of costs, reimbursement, and patient volume in 3 settings: an average US hip fracture program, a highly efficient center, and an academic hospital without a specific hip fracture program. Results were tested with sensitivity analysis. A local market analysis was conducted to assess the feasibility of supporting profitable hip fracture centers. The results demonstrate that hip fracture treatment only becomes profitable when the annual caseload exceeds approximately 72, assuming costs characteristic of a typical US hip fracture program. The threshold of profitability is 49 cases per year for high-efficiency hip fracture centers and 151 for the urban academic hospital under review. The largest determinant of profit is reimbursement, followed by costs and volume. In the authors’ home market, 168 hospitals offer hip fracture care, yet 85% fall below the 72-case threshold. Hip fracture centers can be highly profitable through low costs and, especially, high revenues. However, most hospitals likely lose money by offering hip fracture care due to inadequate volume. Thus, both large and small facilities would benefit financially from the consolidation of hip fracture care at dedicated hip fracture centers. Typical US cities have adequate volume to support several such centers.

  16. Fractal patterns of fractures in granites (United States)

    Velde, B.; Dubois, J.; Moore, D.; Touchard, G.


    Fractal measurements using the Cantor's dust method in a linear one-dimensional analysis mode were made on the fracture patterns revealed on two-dimensional, planar surfaces in four granites. This method allows one to conclude that: 1. (1)|The fracture systems seen on two-dimensional surfaces in granites are consistent with the part of fractal theory that predicts a repetition of patterns on different scales of observation, self similarity. Fractal analysis gives essentially the same values of D on the scale of kilometres, metres and centimetres (five orders of magnitude) using mapped, surface fracture patterns in a Sierra Nevada granite batholith (Mt. Abbot quadrangle, Calif.). 2. (2)|Fractures show the same fractal values at different depths in a given batholith. Mapped fractures (main stage ore veins) at three mining levels (over a 700 m depth interval) of the Boulder batholith, Butte, Mont. show the same fractal values although the fracture disposition appears to be different at different levels. 3. (3)|Different sets of fracture planes in a granite batholith, Central France, and in experimental deformation can have different fractal values. In these examples shear and tension modes have the same fractal values while compressional fractures follow a different fractal mode of failure. The composite fracture patterns are also fractal but with a different, median, fractal value compared to the individual values for the fracture plane sets. These observations indicate that the fractal method can possibly be used to distinguish fractures of different origins in a complex system. It is concluded that granites fracture in a fractal manner which can be followed at many scales. It appears that fracture planes of different origins can be characterized using linear fractal analysis. ?? 1991.


    Directory of Open Access Journals (Sweden)

    Ivan Golubović


    Full Text Available Laugier's fractures are rare because they are located deep in the elbow joint and are thus protected from any direct trauma. This study shows two patients whose Laugier's fractures were surgically treated. Surgical interventions were performed using the Campbell surgical approach. The ulnar nerve was mobilised for a distance of 12 cm, and then a tenotomy of the triceps brachii muscle and a posterior capsulectomy of the elbow joint were performed. A temporary repositioning followed by a permanent fixation were undertaken using two 3.2mm screws. The screws were inserted from the back, through the posterolateral and posteromedial pillars of the humeral condyle, to the front and medially. The tip of the screw was kept subchondrally in the bone of the humeral capitellum or trochlea and did not go through the cartilage. The stitches of the wound were done by layers, and prior to that a transposition of the ulnar nerve was performed medially. A plaster cast was worn on the upper arm for three weeks, with mandatory prophylaxis of periarticular ossification by taking indomethacin, 25mg three times a day. Upon removing the plaster cast, the patients underwent outpatient physical therapy for two weeks followed by inpatient physical therapy with full weight-bearing. Laugier's fractures have been insufficiently described in the literature. Surgical treatment does not have an alternative, and timely diagnosis and surgical and physical therapy yield, according to the Mayo elbow performance index, good results.

  18. Plating of proximal humeral fractures. (United States)

    Martetschläger, Frank; Siebenlist, Sebastian; Weier, Michael; Sandmann, Gunther; Ahrens, Philipp; Braun, Karl; Elser, Florian; Stöckle, Ulrich; Freude, Thomas


    The optimal treatment for proximal humeral fractures is controversial. Few data exist concerning the influence of the surgical approach on the outcome. The purpose of this study was to evaluate the clinical and radiological outcomes of proximal humeral fractures treated with locking plate fixation through a deltopectoral vs an anterolateral deltoid-splitting approach. Of 86 patients who met the inclusion criteria, 70 were available for follow-up examination. Thirty-three patients were treated through a deltopectoral approach and 37 through an anterolateral deltoid-splitting approach. In all cases, open reduction and internal fixation with a PHILOS locking plate (Synthes, Umkirch, Germany) was performed. Clinical follow-up included evaluation of pain, shoulder mobility, and strength. Constant score and Disabilities of the Arm, Shoulder and Hand (DASH) score were assessed. A clinical neurological examination of the axillary nerve was also performed. Consolidation, reduction, and appearance of head necrosis were evaluated radiographically. After a mean follow-up of 33 months, Constant scores, DASH scores, and American Shoulder and Elbow Surgeons scores showed no significant differences between the groups. Clinical neurologic examination of the axillary nerve revealed no obvious damage to the nerve in either group. Deltopectoral and anterolateral detoid-splitting approaches for plate fixation of proximal humeral fractures are safe and provide similar clinical outcomes. The results of this study suggest that the approach can be chosen according to surgeon preference.

  19. Bending fracture in carbon nanotubes. (United States)

    Kuo, Wen-Shyong; Lu, Hsin-Fang


    A novel approach was adopted to incur bending fracture in carbon nanotubes (CNTs). Expanded graphite (EG) was made by intercalating and exfoliating natural graphite flakes. The EG was deposited with nickel particles, from which CNTs were grown by chemical vapor deposition. The CNTs were tip-grown, and their roots were fixed on the EG flakes. The EG flakes were compressed, and many CNTs on the surface were fragmented due to the compression-induced bending. Two major modes of the bending fracture were observed: cone-shaped and shear-cut. High-resolution scanning electron microscopy (SEM) and transmission electron microscopy (TEM) were used to examine the crack growth within the graphene layers. The bending fracture is characterized by two-region crack growth. An opening crack first appears around the outer-tube due to the bending-induced tensile stress. The crack then branches to grow along an inclined direction toward the inner-tube due to the presence of the shear stress in between graphene layers. An inner-tube pullout with inclined side surface is formed. The onset and development of the crack in these two regions are discussed.

  20. Fracture mechanics of protein materials

    Directory of Open Access Journals (Sweden)

    Markus J. Buehler


    Full Text Available Proteins are the fundamental building blocks of a vast array of biological materials involved in critical functions of life, many of which are based on highly characteristic nanostructured arrangements of protein components that include collagen, alpha helices, or beta sheets. Bone, providing structure to our body, or spider silk, used for prey procurement, are examples of materials that have incredible elasticity, strength, and robustness unmatched by many synthetic materials. This is mainly attributed to their structural formation with molecular precision. We review recent advances in using large-scale atomistic and molecular modeling to elucidate the deformation and fracture mechanics of vimentin intermediate filaments (IFs, which are hierarchical self-assembled protein networks that provide structure and stability to eukaryotic cells. We compare the fracture and failure mechanisms of biological protein materials (BPMs with those observed in brittle and ductile crystalline materials such as metals or ceramics. Our studies illustrate how atomistic-based multiscale modeling can be employed to provide a first principles based material description of deformation and fracture, linking nano- to macroscales.

  1. Continuum damage and fracture mechanics

    CERN Document Server

    Öchsner, Andreas


    This textbook offers readers an introduction to damage and fracture mechanics, equipping them to grasp the basic ideas of the presented approaches to modeling in applied mechanics. In the first part, the book reviews and expands on the classical theory of elastic and elasto-plastic material behavior. A solid understanding of these two topics is the essential prerequisite to advancing to damage and fracture mechanics. Thus, the second part of this course provides an introduction to the treatment of damage and fractures in the context of applied mechanics. Wherever possible, the one-dimensional case is first introduced and then generalized in a following step. This departs somewhat from the more classical approach, where first the most general case is derived and then simplified to special cases. In general, the required mathematics background is kept to a minimum.   Tutorials are included at the end of each chapter, presenting the major steps for the solution and offering valuable tips and tricks. The supplem...

  2. Simulation of complex fracture networks influenced by natural fractures in shale gas reservoir

    Directory of Open Access Journals (Sweden)

    Zhao Jinzhou


    Full Text Available When hydraulic fractures intersect with natural fractures, the geometry and complexity of a fracture network are determined by the initiation and propagation pattern which is affected by a number of factors. Based on the fracture mechanics, the criterion for initiation and propagation of a fracture was introduced to analyze the tendency of a propagating angle and factors affecting propagating pressure. On this basis, a mathematic model with a complex fracture network was established to investigate how the fracture network form changes with different parameters, including rock mechanics, in-situ stress distribution, fracture properties, and frac treatment parameters. The solving process of this model was accelerated by classifying the calculation nodes on the extending direction of the fracture by equal pressure gradients, and solving the geometrical parameters prior to the iteration fitting flow distribution. With the initiation and propagation criterion as the bases for the propagation of branch fractures, this method decreased the iteration times through eliminating the fitting of the fracture length in conventional 3D fracture simulation. The simulation results indicated that the formation with abundant natural fractures and smaller in-situ stress difference is sufficient conditions for fracture network development. If the pressure in the hydraulic fractures can be kept at a high level by temporary sealing or diversion, the branch fractures will propagate further with minor curvature radius, thus enlarging the reservoir stimulation area. The simulated shape of fracture network can be well matched with the field microseismic mapping in data point range and distribution density, validating the accuracy of this model.

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

    Institute of Scientific and Technical Information of China (English)

    Shen Jinsong; Su Benyu; Guo Naichuan


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

  4. Fluid Compressibility Effects during Hydraulic Fracture: an Opportunity for Gas Fracture Revival (United States)

    Mighani, S.; Boulenouar, A.; Moradian, Z.; Evans, J. B.; Bernabe, Y.


    Hydraulic fracturing results when internal pore pressure is increased above a critical value. As the fracture extends, the fluid flows to the crack tip. The fracturing process depends strongly on the physical properties of both the porous solid and the fluid (e.g. porosity and elastic moduli for the solid, viscosity and compressibility for the fluid). It is also affected by the in-situ stress and pore pressure conditions. Here, we focus on the effect of fluid properties on hydraulic fracturing under conventional triaxial loading. Cylinders of Solnhofen limestone (a fine-grained, low permeability rock) were prepared with a central borehole through which different pressurized fluids such as oil, water or argon, were introduced. Preliminary experiments were performed using a confining pressure of 5 MPa and axial stress of 7 MPa. Our goal was to monitor fracture extension using strain gauges, acoustic emissions (AE) recording and ultrasonic velocity measurements. We also tried to compare the data with analytical models of fracture propagation. Initial tests showed that simple bi-wing fractures form when the fracturing fluid is relatively incompressible. With argon as pore fluid, a complex fracture network was formed. We also observed that the breakdown pressure was higher with argon than with less compressible fluids. After fracturing occurred, we cycled fluid pressure for several times. During the first cycles, re-opening of the fracture was associated with additional propagation. In general, it took 4 cycles to inhibit further propagation. Analytical models suggest that initial fractures occurring with compressible fluids tend to stabilize. Hence, formation and extension of additional fractures may occur, leading to a more complex morphology. Conversely, fractures formed by incompressible fluids remain critically stressed as they extend, thus producing a simple bi-wing fracture. Using compressible fracturing fluids could be a suitable candidate for an efficient

  5. Guiding-controlling technology of coal seam hydraulic fracturing fractures extension

    Institute of Scientific and Technical Information of China (English)

    Zhai; Cheng; Li; Min; Sun; Chen; Zhang; Jianguo; Yang; Wei; Li; Quangui


    Aiming at the uncontrollable problem of extension direction of coal seam hydraulic fracturing,this study analyzed the course of fractures variation around the boreholes in process of hydraulic fracturing,and carried out the numerical simulations to investigate the effect of artificial predetermined fractures on stress distribution around fractured holes.The simulation results show that partial coal mass occurs relatively strong shear failure and forms weak surfaces,and then fractures extended along the desired direction while predetermined fractures changed stress distribution.Directional fracturing makes the fractures link up and the pressure on coal mass is relieved within fractured regions.Combining deep hole controlling blasting with hydraulic fracturing was proposed to realize the extension guiding-controlling technology of coal seam fractures.Industrial experiments prove that this technology can avoid local stress concentration and dramatically widen the pressure relief scope of deep hole controlling blasting.The permeability of fractured coal seam increased significantly,and gas extraction was greatly improved.Besides,regional pressure relief and permeability increase was achieved in this study.

  6. Discrete Fracture Network Modelling in a Naturally Fractured Carbonate Reservoir in the Jingbei Oilfield, China

    Directory of Open Access Journals (Sweden)

    Junling Fang


    Full Text Available This paper presents an integrated approach of discrete fracture network modelling for a naturally fractured buried-hill carbonate reservoir in the Jingbei Oilfield by using a 3D seismic survey, conventional well logs, and core data. The ant tracking attribute, extracted from 3D seismic data, is used to detect the faults and large-scale fractures. Fracture density and dip angle are evaluated by observing drilling cores of seven wells. The fracture density distribution in spatiality was predicted in four steps; firstly, the ant tracking attribute was extracted as a geophysical log; then an artificial neural network model was built by relating the fracture density with logs, e.g., acoustic, gamma ray, compensated neutron, density, and ant tracking; then 3D distribution models of acoustic, gamma ray, compensated neutron and density were generated by using a Gaussian random function simulation; and, finally, the fracture density distribution in 3D was predicted by using the generated artificial neural network model. Then, different methods were used to build the discrete fracture network model for different types of fractures of which large-scale fractures were modelled deterministically and small-scale fractures were modelled stochastically. The results show that the workflow presented in this study is effective for building discrete fracture network models for naturally fractured reservoirs.

  7. Sports-related fractures in South East Scotland: an analysis of 990 fractures. (United States)

    Aitken, Stuart A; Watson, Bruce S; Wood, Alexander M; Court-Brown, Charles M


    To describe the characteristics of all sports related fractures in patients aged ≥ 15 years in South East Scotland in one year. Medical records of 990 consecutive patients aged ≥ 15 years who presented to the Orthopaedic Trauma Unit of the Royal Infirmary of Edinburgh with sports-related fractures between 1 July 2007 and 30 June 2008 were reviewed. Acute fractures of the upper limbs, lower limbs, pelvis, and cervical spine were included, but those of the skull, facial bones, and thorax were excluded, as were stress and chronic fractures. The incidence of sports-related fractures was 1.8/1000/year (82% involving men). The median age of patients was 25 (interquartile range, 19-35) years. Sports-related fractures accounted for 24.6% and 5.1% of all fractures in men and women, respectively. Men aged 15 to 19 years were 9 times more likely to have sports-related fractures than women of the same age. The sports-related fractures involved the upper limbs (52.4%), lower limbs (45.4%), and axial skeleton (2.2%). 12 of 49 sports (football, rugby, skiing, snowboarding, 3 cycling disciplines, horse riding, motocross, basketball, martial arts, and ice skating) accounted for 82.8% of all sports-related fractures. Upper limb fractures outnumbered lower limb fractures in all sports, except for horse riding and motocross that the proportions were similar. In South East Scotland, most sports related fractures involved the upper limbs.

  8. Prevalence and Cost of Subsequent Fractures Among U.S. Patients with an Incident Fracture. (United States)

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


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

  9. Open Calcaneus Fractures and Associated Injuries. (United States)

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


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

  10. Acidization of shales with calcite cemented fractures (United States)

    Kwiatkowski, Kamil; Szymczak, Piotr; Jarosiński, Marek


    Investigation of cores drilled from shale formations reveals a relatively large number of calcite-cemented fractures. Usually such fractures are reactivated during fracking and can contribute considerably to the permeability of the resulting fracture network. However, calcite coating on their surfaces effectively excludes them from production. Dissolution of the calcite cement by acidic fluids is investigated numerically with focus on the evolution of fracture morphology. Available surface area, breakthrough time, and reactant penetration length are calculated. Natural fractures in cores from Pomeranian shale formation (northern Poland) were analyzed and classified. Representative fractures are relatively thin (0.1 mm), flat and completely sealed with calcite. Next, the morphology evolution of reactivated natural fractures treated with low-pH fluids has been simulated numerically under various operating conditions. Depth-averaged equations for fracture flow and reactant transport has been solved by finite-difference method coupled with sparse-matrix solver. Transport-limited dissolution has been considered, which corresponds to the treatment with strong acids, such as HCl. Calcite coating in reactivated natural fractures dissolves in a highly non-homogeneous manner - a positive feedback between fluid transport and calcite dissolution leads to the spontaneous formation of wormhole-like patterns, in which most of the flow is focused. The wormholes carry reactive fluids deeper inside the system, which dramatically increases the range of the treatment. Non-uniformity of the dissolution patterns provides a way of retaining the fracture permeability even in the absence of the proppant, since the less dissolved regions will act as supports to keep more dissolved regions open. Evolution of fracture morphology is shown to depend strongly on the thickness of calcite layer - the thicker the coating the more pronounced wormholes are observed. However the interaction between

  11. Elastic waves along a fracture intersection (United States)

    Abell, Bradley Charles

    Fractures and fracture networks play a significant role in the subsurface hydraulic connectivity within the Earth. While a significant amount of research has been performed on the seismic response of single fractures and sets of fractures, few studies have examined the effect of fracture intersections on elastic wave propagation. Intersections play a key role in the connectivity of a fracture network that ultimately affects the hydraulic integrity of a rock mass. In this dissertation two new types of coupled waves are examined that propagate along intersections. 1) A coupled wedge wave that propagates along a surface fracture with particle motion highly localized to the intersection of a fracture with a free surface, and 2) fracture intersection waves that propagate along the intersection between two orthogonal fractures. Theoretical formulations were derived to determine the particle motion and velocity of intersection waves. Vibrational modes calculated from the theoretical formulation match those predicted by group theory based on the symmetry of the problem. For the coupled wedge wave, two vibrational modes exist that range in velocity between the wedge wave and Rayleigh wave velocity and exhibit either wagging or breathing motion depending on the Poisson's ratio. For the intersection waves, the observed modes depend on the properties of the fractures forming the intersection. If both fractures have equal stiffness four modes exist, two with wagging and two with breathing motion. If the fractures have unequal stiffness, four modes also exist, but the motion depends on the Poisson's ratio. The velocity of intersection waves depends on the coupling or stiffness of the intersection and frequency of the signal. In general, the different modes travel with speeds between the wedge wave and bulk shear wave velocity. Laboratory experiments were performed on isotropic and anisotropic samples to verify the existence of these waves. For both waves, the observed signals

  12. Prospective study of ankle and foot fractures in elderly women

    Directory of Open Access Journals (Sweden)

    Yadagiri Surender Rao


    Full Text Available The epidemiology of ankle fractures in old people is changing as time passes on. The incidence of ankle fractures increases with advancing age. The study conducted was among a rural popula-tion which comprised of 68 women (32 women with ankle fractures & 36 women with foot fractures. Patients studied were in the age group more than 50 years. The study highlights the etiological & risk factors for fractures of ankle & foot. The commonest ankle fracture was the lateral malleolar fracture & the commonest foot fracture was the 5th Metatarsal fracture. Diabetes is a risk factor which increases the occurrence of ankle and foot injuries.

  13. Ischial apophyseal fracture in an abused infant

    Energy Technology Data Exchange (ETDEWEB)

    Bixby, Sarah D.; Kleinman, Paul K. [Boston Children' s Hospital, Department of Radiology, Boston, MA (United States); Wilson, Celeste R. [Boston Children' s Hospital, Child Protection Program, Department of Pediatrics, Boston, MA (United States); Barber, Ignasi [Hospital Vall d' Hebron, Department of Pediatric Radiology, Barcelona (Spain)


    We report a previously healthy 4-month-old who presented to the hospital with leg pain and swelling and no history of trauma. Radiographs demonstrated a comminuted left femur fracture. Given the concern for child abuse, skeletal survey was performed and revealed four vertebral compression deformities. Although abuse was suspected, the possibility of a lytic lesion associated with the femur fracture and multiple spinal abnormalities raised the possibility of an underlying process such as Langerhans cell histiocytosis. Subsequently 18F-NaF positron emission tomographic (PET) scintigraphy revealed increased tracer activity in the ischium, and MRI confirmed an ischial apophyseal fracture. Pelvic fractures, particularly ischial fractures, are extremely rare in the setting of child abuse. This case report describes the multimodality imaging findings of an ischial fracture in an abused infant. (orig.)

  14. Neglected isolated fracture of the trochlea humeri

    Institute of Scientific and Technical Information of China (English)

    Ajay Pal Singh; Ish Kumar Dhammi; Anil Kumar Jain; Saurabh Jain


    A 15 years old girl was found to have isolated trochlea fracture 10 weeks after an injury caused by a fall on her left elbow. Movement of the elbow was severely restricted. Radiographs showed a half moon-shaped and anterosuperiorly displaced osteochondral fragment. Medial approach capsulotomy of the elbow and excision of the intraarticular adhesions were done to expose the isolated trochlea fracture. Headless screws were used for fixation,combined with bone grafting. The follow-up showed union and excellent functional recovery of the elbow. Isolated trochlea fracture in adults is rare and usually associated with capitellar fractures and/or elbow dislocations. A neglected trochlea fracture is rarely reported in the English language literature to the best of our knowledge. Recognition of isolated trochlea fracture is vital to apprehend the pathomechanics of the injury and to devise a suitable treatment approach.

  15. Intelligent fracture creation for shale gas development

    KAUST Repository

    Douglas, Craig C.


    Shale gas represents a major fraction of the proven reserves of natural gas in the United States and a collection of other countries. Higher gas prices and the need for cleaner fuels provides motivation for commercializing shale gas deposits even though the cost is substantially higher than traditional gas deposits. Recent advances in horizontal drilling and multistage hydraulic fracturing, which dramatically lower costs of developing shale gas fields, are key to renewed interest in shale gas deposits. Hydraulically induced fractures are quite complex in shale gas reservoirs. Massive, multistage, multiple cluster treatments lead to fractures that interact with existing fractures (whether natural or induced earlier). A dynamic approach to the fracturing process so that the resulting network of reservoirs is known during the drilling and fracturing process is economically enticing. The process needs to be automatic and done in faster than real-time in order to be useful to the drilling crews.

  16. Female athlete triad and stress fractures. (United States)

    Feingold, David; Hame, Sharon L


    Stress fractures are a common occurrence in athletes, and the incidence of stress fractures in female Division 1 collegiate athletes is double that of men. Hormonal influences on bone and bone morphology may influence the risk for fracture. A high level of suspicion and special imaging procedures allow for accurate diagnosis of these fractures. In stress fractures that are associated with the female athlete triad, addressing the three aspects of the triad--eating disorders, amenorrhea, and osteoporosis--are critical for successful treatment. Preparticipation screening for the presence of signs of the female athlete triad by monitoring weight, energy level, menstrual cycles, and bone mineral density may help to prevent the occurrence of stress fractures in this population.

  17. Hip fracture in hospitalized medical patients

    Directory of Open Access Journals (Sweden)

    Zapatero Antonio


    Full Text Available Abstract Background The aim of the present study is to analyze the incidence of hip fracture as a complication of admissions to internal medicine units in Spain. Methods We analyzed the clinical data of 2,134,363 adults who had been admitted to internal medicine wards. The main outcome was a diagnosis of hip fracture during hospitalization. Outcome measures included rates of in-hospital fractures, length of stay and cost. Results A total of 1127 (0.057% admittances were coded with an in-hospital hip fracture. In hospital mortality rate was 27.9% vs 9.4%; p  Conclusions In-hospital hip fracture notably increased mortality during hospitalization, doubling the mean length of stay and mean cost of admission. These are reasons enough to stress the importance of designing and applying multidisciplinary plans focused on reducing the incidence of hip fractures in hospitalized patients.

  18. Recent trends in fracture and damage mechanics

    CERN Document Server

    Zybell, Lutz


    This book covers a wide range of topics in fracture and damage mechanics. It presents historical perspectives as well as recent innovative developments, presented by peer reviewed contributions from internationally acknowledged authors.  The volume deals with the modeling of fracture and damage in smart materials, current industrial applications of fracture mechanics, and it explores advances in fracture testing methods. In addition, readers will discover trends in the field of local approach to fracture and approaches using analytical mechanics. Scholars in the fields of materials science, engineering and computational science will value this volume which is dedicated to Meinhard Kuna on the occasion of his 65th birthday in 2015. This book incorporates the proceedings of an international symposium that was organized to honor Meinhard Kuna’s contributions to the field of theoretical and applied fracture and damage mechanics.

  19. [Triple fracture of the shoulder suspensory complex]. (United States)

    Tamimi Mariño, I; Martin Rodríguez, I; Mora Villadeamigo, J


    The superior suspensory complex of the shoulder (SSCS) is a ring shaped structure composed of bones and soft tissues that play a fundamental role in the stability of the shoulder joint. Isolated injuries of the SSCS are relatively common, but injuries that affect 3 components are extremely unusual. We present a triple injury of the SSCS in a 26 year old patient with a Neer type ii clavicular fracture, a Kuhn type iii acromion fracture and an Ogawa type i coracoid fracture. An open reduction and stabilization of the clavicle was performed with 2 Kirschner nails. The acromial fracture was synthesized with 2 cannulated screws, and the coracoid fracture was treated conservatively. After 24 months of follow up the patient had an excellent functional outcome according to the Constat-Murley shoulder score and QuickDASH scoring system, and all the fractures healed correctly. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  20. Ulnar nerve paralysis after forearm bone fracture. (United States)

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


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

  1. Evaluation and Management of Proximal Humerus Fractures

    Directory of Open Access Journals (Sweden)

    Ekaterina Khmelnitskaya


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

  2. Finite element analysis of tibial fractures

    DEFF Research Database (Denmark)

    Wong, Christian Nai En; Mikkelsen, Mikkel Peter W; Hansen, Leif Berner


    INTRODUCTION: Fractures of the tibial shaft are relatively common injuries. There are indications that tibial shaft fractures share characteristics in terms of site, type and local fracture mechanisms. In this study, we aimed to set up a mathematical, computer-based model using finite element...... analysis of the bones of the lower leg to examine if such a model is adequate for prediction of fracture locations and patterns. In future studies, we aim to use these biomechanical results to examine fracture prevention, among others, and to simulate different types of osteosynthesis and the process...... of bony healing. The biomechanical results are the basis for fracture healing, biomechanical fall analysis and stability analysis of osteosynthesis. MATERIAL AND METHODS: A finite element model of the bony part of the lower leg was generated on the basis of computed tomography data from the Visible Human...

  3. Humerus shaft fractures - where are we today?

    DEFF Research Database (Denmark)

    Strohm, P C; Reising, K; Hammer, T


    Humeral shaft fractures account for about 1-3% of all fractures. These fractures are regarded as the domain of non-surgical management. This is certainly still the contemporary view but there is an obvious trend towards surgical stabilization. Surgical treatment of humeral shaft fractures has...... nonetheless been greatly facilitated by the development of new implants. In particular, a new generation of nails that general permit immediate mobilization have become available for improved management of longitudinal and multi-segmental fractures. Retrograde and antegrade nails have advantages...... and disadvantages and selection procedure is often based on the distal or proximal location of the fracture. Plates also offer an alternative for certain indications and have advantages at the proximal and distal shaft in particular. If there is primary lesion of the radial nerve, exploration is not very advisable...

  4. Atypical subtrochanteric and diaphyseal femoral fractures

    DEFF Research Database (Denmark)

    Shane, Elizabeth; Burr, David; Abrahamsen, Bo


    Bisphosphonates (BPs) and denosumab reduce the risk of spine and nonspine fractures. Atypical femur fractures (AFFs) located in the subtrochanteric region and diaphysis of the femur have been reported in patients taking BPs and in patients on denosumab, but they also occur in patients...... with no exposure to these drugs. In this report, we review studies on the epidemiology, pathogenesis, and medical management of AFFs, published since 2010. This newer evidence suggests that AFFs are stress or insufficiency fractures. The original case definition was revised to highlight radiographic features...... that distinguish AFFs from ordinary osteoporotic femoral diaphyseal fractures and to provide guidance on the importance of their transverse orientation. The requirement that fractures be noncomminuted was relaxed to include minimal comminution. The periosteal stress reaction at the fracture site was changed from...

  5. Finite element analysis of tibial fractures

    DEFF Research Database (Denmark)

    Wong, Christian Nai En; Mikkelsen, Mikkel Peter W; Hansen, Leif Berner


    INTRODUCTION: Fractures of the tibial shaft are relatively common injuries. There are indications that tibial shaft fractures share characteristics in terms of site, type and local fracture mechanisms. In this study, we aimed to set up a mathematical, computer-based model using finite element...... analysis of the bones of the lower leg to examine if such a model is adequate for prediction of fracture locations and patterns. In future studies, we aim to use these biomechanical results to examine fracture prevention, among others, and to simulate different types of osteosynthesis and the process...... Project. The data consisted of 21,219 3D elements with a cortical shell and a trabecular core. Three types of load of torsion, a direct lateral load and axial compression were applied. RESULTS: The finite element linear static analysis resulted in relevant fracture localizations and indicated relevant...

  6. Ulnar nerve paralysis after forearm bone fracture

    Directory of Open Access Journals (Sweden)

    Carlos Roberto Schwartsmann


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

  7. Hydraulic fracturing chemicals and fluids technology

    CERN Document Server

    Fink, Johannes


    When classifying fracturing fluids and their additives, it is important that production, operation, and completion engineers understand which chemical should be utilized in different well environments. A user's guide to the many chemicals and chemical additives used in hydraulic fracturing operations, Hydraulic Fracturing Chemicals and Fluids Technology provides an easy-to-use manual to create fluid formulations that will meet project-specific needs while protecting the environment and the life of the well. Fink creates a concise and comprehensive reference that enables the engineer to logically select and use the appropriate chemicals on any hydraulic fracturing job. The first book devoted entirely to hydraulic fracturing chemicals, Fink eliminates the guesswork so the engineer can select the best chemicals needed on the job while providing the best protection for the well, workers and environment. Pinpoints the specific compounds used in any given fracturing operation Provides a systematic approach to class...

  8. At-sea test system point design for a one-third scale cold water pipe

    Energy Technology Data Exchange (ETDEWEB)

    Sutherland, W.H. (ed.)


    One step in the development of the technology for Ocean Thermal Energy Conversion (OTEC) Cold Water Pipes (CWP) is the at-sea testing of a fiberglass reinforced plastic nominal 10-foot diameter pipe. A design procedure and criteria for developing test hardware by scaling down a 30-foot diameter OTEC 10/40 MW Pilot Plant CWP design are presented. An example point design for the pipe, instrumentation to be used during the at-sea tests, and methods for selecting the support platform and mooring are described. The design considered starts with a scale model of a larger prototype, and then is modified to address the problems of fabrication and of survivability and handling during the 1/3rd scale model tests.

  9. One-third (period three) harmonic generation in microwave-driven Josephson tunnel junctions

    DEFF Research Database (Denmark)

    Hansen, Jørn Bindslev; Clarke, J.; Mygind, Jesper;


    parameters and microwave current were measured in situ in separate experiments. The subharmonic generation occurred for ranges of microwave current and frequency that were in reasonable agreement with the results of digital computer simulations. Applied Physics Letters is copyrighted by The American...... Institute of Physics....

  10. GOLD criteria overestimate airflow limitation in one-third of cases in the general Finnish population

    Directory of Open Access Journals (Sweden)

    Annette Kainu


    Full Text Available The Global Initiative for Chronic Obstructive Lung Disease (GOLD diagnostic criteria for chronic obstructive pulmonary disease (COPD use a fixed threshold of forced expiratory volume in 1 s (FEV1/forced vital capacity (FVC ratio (<0.70 in post-bronchodilation spirometry to indicate disease, which has been shown to underestimate and overestimate disease prevalence in younger and older adults, respectively, whilst criteria based on reference values have better accuracy. Differences in reference values have limited their use in international studies. However, the new Global Lung Function Initiative reference values (GLI2012 showed FEV1/FVC to be the least dependent on ethnicity. The aim of this study was to assess the prevalence of airflow limitation with GLI2012 and the degree of underdetection or overestimation related to the use of GOLD in the general population. A Finnish population sample of 1323 subjects (45% male with post-bronchodilation spirometry was studied. 80 subjects (6.0% and 55 subjects (4.2% were identified with airflow limitation with GOLD and GLI2012 criteria, respectively. The proportion of overestimation with GOLD increased with age from 25% of cases in 50-year-olds to 54% in 70-year-olds. Using z-score-based grading resulted in more dispersion in severity grading. In conclusion, the GOLD criteria cause a marked overestimation already from 50-year-olds and should be replaced with the GLI2012 criteria to improve diagnostic accuracy.

  11. Stereotyped B-cell receptors in one-third of chronic lymphocytic leukemia

    DEFF Research Database (Denmark)

    Agathangelidis, Andreas; Darzentas, Nikos; Hadzidimitriou, Anastasia


    Mounting evidence indicates that grouping of chronic lymphocytic leukemia (CLL) into distinct subsets with stereotyped BCRs is functionally and prognostically relevant. However, several issues need revisiting, including the criteria for identification of BCR stereotypy and its actual frequency...... as well as the identification of "CLL-biased" features in BCR Ig stereotypes. To this end, we examined 7596 Ig VH (IGHV-IGHD-IGHJ) sequences from 7424 CLL patients, 3 times the size of the largest published series, with an updated version of our purpose-built clustering algorithm. We document that CLL may...... be subdivided into 2 distinct categories: one with stereotyped and the other with nonstereotyped BCRs, at an approximate ratio of 1:2, and provide evidence suggesting a different ontogeny for these 2 categories. We also show that subset-defining sequence patterns in CLL differ from those underlying BCR...

  12. One-Third Magnetization Plateau with a Preceding Novel Phase in Volborthite (United States)

    Ishikawa, H.; Yoshida, M.; Nawa, K.; Jeong, M.; Krämer, S.; Horvatić, M.; Berthier, C.; Takigawa, M.; Akaki, M.; Miyake, A.; Tokunaga, M.; Kindo, K.; Yamaura, J.; Okamoto, Y.; Hiroi, Z.


    We have synthesized high-quality single crystals of volborthite, a seemingly distorted kagome antiferromagnet, and carried out high-field magnetization measurements up to 74 T and V 51 NMR measurements up to 30 T. An extremely wide 1 /3 magnetization plateau appears above 28 T and continues over 74 T at 1.4 K, which has not been observed in previous studies using polycrystalline samples. NMR spectra reveal an incommensurate order (most likely a spin-density wave order) below 22 T and a simple spin structure in the plateau phase. Moreover, a novel intermediate phase is found between 23 and 26 T, where the magnetization varies linearly with magnetic field and the NMR spectra indicate an inhomogeneous distribution of the internal magnetic field. This sequence of phases in volborthite bears a striking similarity to those of frustrated spin chains with a ferromagnetic nearest-neighbor coupling J1 competing with an antiferromagnetic next-nearest-neighbor coupling J2 .

  13. One third of middle ear effusions from children undergoing tympanostomy tube placement had multiple bacterial pathogens

    Directory of Open Access Journals (Sweden)

    Holder Robert C


    Full Text Available Abstract Background Because previous studies have indicated that otitis media may be a polymicrobial disease, we prospectively analyzed middle ear effusions of children undergoing tympanostomy tube placement with multiplex polymerase chain reaction for four otopathogens. Methods Middle ear effusions from 207 children undergoing routine tympanostomy tube placement were collected and were classified by the surgeon as acute otitis media (AOM for purulent effusions and as otitis media with effusion (OME for non-purulent effusions. DNA was isolated from these samples and analyzed with multiplex polymerase chain reaction for Haemophilus influenzae, Streptococcus pneumoniae, Alloiococcus otitidis, and Moraxella catarrhalis. Results 119 (57% of 207 patients were PCR positive for at least one of these four organisms. 36 (30% of the positive samples indicated the presence of more than one bacterial species. Patient samples were further separated into 2 groups based on clinical presentation at the time of surgery. Samples were categorized as acute otitis media (AOM if pus was observed behind the tympanic membrane. If no pus was present, samples were categorized as otitis media with effusion (OME. Bacteria were identified in most of the children with AOM (87% and half the children with OME (51%, p Haemophilus influenzae was the predominant single organism and caused 58% of all AOM in this study. Alloiococcus otitidis and Moraxella catarrhalis were more frequently identified in middle ear effusions than Streptococcus pneumoniae. Conclusions Haemophilus influenzae, Streptococcus pneumoniae, Alloiococcus otitidis, and Moraxella catarrhalis were identified in the middle ear effusions of some patients with otitis media. Overall, we found AOM is predominantly a single organism infection and most commonly from Haemophilus influenzae. In contrast, OME infections had a more equal distribution of single organisms, polymicrobial entities, and non-bacterial agents.

  14. Korea: household distribution program resulted in one-third increase in effective method use. (United States)


    The government subsidized family planning program in South Korea is the most successful in the developing world. Although 36% of the married women of childbearing age are users of modern contraceptive methods, the program has been stabilized at this level for the past several years. Lee Jay Cho of the East-West Population Institute and the University of Hawaii and his colleagues have identified the following 6 major problems with the clinic-based national program in Korea as possibly responsible for the plateauing in contraceptive use: 1) too large a caseload for each worker; 2) target setting, resulting in an emphasis on quantity rather than quality; 3) too much stress on the IUD even when a preference for another method is indicated; 4) not enough supply and service points to take care of the needs of rural residents; 5) obstacles to acceptance created by red tape and complicated bureaucrataic administrative procedures; and 6) poor quality and limitation of contraceptive supplies. Cho and his group went on to initiate an experiment in comprehensive household distribution in May 1975 in an attempt to stimulate an increase in contraceptive use. 3 methods of household distribution were used in the experiment and, despite the limitations of 2 of the approaches, for the 4-month period of the experiment there was a 1/3 increase in the use of modern contraceptives in these villages.

  15. Nearly One-Third Of Enrollees In California's Individual Market Missed Opportunities To Receive Financial Assistance. (United States)

    Fung, Vicki; Liang, Catherine Y; Donelan, Karen; Peitzman, Cassandra G K; Dow, William H; Zaslavsky, Alan M; Fireman, Bruce; Derose, Stephen F; Chernew, Michael E; Newhouse, Joseph P; Hsu, John


    The Affordable Care Act includes financial assistance that reduces both premiums and cost-sharing amounts for lower-income Americans, to increase the affordability of health insurance coverage and care. To receive both types of assistance, enrollees must purchase a qualified health plan through a public insurance exchange, and those eligible for the cost-sharing reduction must purchase a silver-tier plan. We estimate that 31 percent of individual-market enrollees in California who were likely eligible for financial assistance purchased plans that were not silver tier or that were not sold on the state's exchange and thus missed opportunities to receive premium or cost-sharing assistance or both. Lower-income enrollees who chose plans not eligible for subsidies had two to three times higher odds of reporting difficulty paying premiums and out-of-pocket expenses during the year, compared to those who chose eligible plans. Regardless of how the structure of the individual market evolves in the coming years, efforts are likely needed to steer lower-income enrollees away from financially suboptimal plan choices. Project HOPE—The People-to-People Health Foundation, Inc.

  16. Analysis of Combine Harvester Sound Pressure Level in One-Third Octave Band Frequency

    Directory of Open Access Journals (Sweden)

    A Maleki


    Full Text Available Workplace factors such as sound must have the minimum impact on the operators of combine harvester, so that they can guide and control many functions of the combine. In this study, some factors affecting the noise generated by two combine harvesters John Deere 1055 and Sampo 3065 were evaluated. Research factors were engine speed, gear ratios, type of operation and microphone distance. The results of this study indicated that sound pressure level decreased with increasing center frequencies. The sound pressure level of John Deere and Sampo combine at center frequency of 4000 Hz were 87.96 and 84.73 db, respectively. The results showed also that the maximum sound pressure of John Deere and Sampo combines were116db at frequency of 250 Hz and 111.1db at frequency of 40 Hz, respectively.

  17. One-Third of the Globe: The Future of Higher Education in China and India (United States)

    Altbach, Philip G.


    China and India together account for almost 25% of the world's postsecondary student population. Most of the enrolment growth in the coming several decades will be in developing countries, and China and India will contribute a significant proportion of that expansion, since China currently educates only about 20% and India 10% of the age cohort.…

  18. Fracture theory based on the concept of characteristic fracture length of materials

    Institute of Scientific and Technical Information of China (English)

    MUTOH; Yoshiharu


    Fracture theory is a classic,but not a well-dealt with,difficulty in solid mechanics. This paper has proposed the concept of characteristic fracture length of materials from the fact that fracture happens with area failure rather than point failure in materials. A unified theory is then proposed,which can be applied both to smooth and defected materials (whether with micro or macro defects). Brittle fracture tests with specimens of different sizes of holes are carried out to examine the fracture theory. It is found that the fracture stresses obtained by experiments agree well with those predicated by the presented fracture theory. Though the brittle fracture is the focus of the paper,the concept of characteristic length can be easily extended to fatigue or other failure problems.

  19. Numerical analysis of fracture propagation during hydraulic fracturing operations in shale gas systems (United States)

    Researchers used the TOUGH+ geomechanics computational software and simulation system to examine the likelihood of hydraulic fracture propagation (the spread of fractures) traveling long distances to connect with drinking water aquifers.

  20. Is a pelvic fracture a predictor for thoracolumbar spine fractures after blunt trauma?

    NARCIS (Netherlands)

    Pouw, M.H.; Deunk, J.; Brink, M.; Dekker, H.M.; Kool, D.R.; Vugt, A.B. van; Edwards, M.J.R.


    BACKGROUND: Discussion still remains which polytraumatized patients require radiologic thoracolumbar spine (TL spine) screening. The purpose of this study is to determine whether pelvic fractures are associated with TL spine fractures after a blunt trauma. Additionally, the sensitivity of