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Sample records for stress fracture incidence

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

    International Nuclear Information System (INIS)

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

    2002-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Alexander M. Wood

    2014-01-01

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

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

    Science.gov (United States)

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

    2013-12-01

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

  4. Stress Fractures

    Science.gov (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 ...

  5. Stress fractures

    International Nuclear Information System (INIS)

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

    1985-01-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

  7. Stress fractures in athletes

    International Nuclear Information System (INIS)

    Steingruber, I.E.; Wolf, C.; Gruber, H.; Czermak, B.V.; Mallouhi, A.; Jaschke, W.; Gabriel, M.

    2002-01-01

    Stress fractures may pose a diagnostic dilemma for radiologists since they are sometimes difficult to demonstrate on plain films and may simulate a tumour. They were first described in military personnel and professional athletes. Recently, there is an increasing incidence in the general population due to increasing sportive activities. Stress fractures occur most often in the lower extremities, especially in the tibia, the tarsal bone, the metatarsal bone, the femur and the fibula. In the upper extremities, they are commonly found in the humerus, the radius and the ulna. Some fractures of the lower extremities appear to be specific for particular sports, for example, fractures of the tibia affect mostly distance runners. Whereas stress fractures of the upper extremities are generally associated with upper limb-dominated sports. A correct diagnosis requires a careful clinical evaluation. The initial plain radiography may be normal. Further radiological evaluation could be performed by means of computerised tomography, magnetic resonance imaging and bone scanning. The latter two techniques are especially helpful for establishing a correct initial diagnosis. (orig.) [de

  8. Metatarsal stress fractures - aftercare

    Science.gov (United States)

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

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

    Science.gov (United States)

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

    2011-01-01

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

  10. Fracture patterns and stresses in granite

    International Nuclear Information System (INIS)

    Price, N.J.

    1979-01-01

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

  11. Stress fractures in military training

    International Nuclear Information System (INIS)

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

    2002-01-01

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

  12. Stress fractures in military training

    Energy Technology Data Exchange (ETDEWEB)

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

    2002-09-01

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

  13. Stress fractures in athletes

    International Nuclear Information System (INIS)

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

    1984-01-01

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

  14. Stress fractures in athletes

    Energy Technology Data Exchange (ETDEWEB)

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

    1984-12-01

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

  15. Incidence and epidemiology of tibial shaft fractures.

    Science.gov (United States)

    Larsen, Peter; Elsoe, Rasmus; Hansen, Sandra Hope; Graven-Nielsen, Thomas; Laessoe, Uffe; Rasmussen, Sten

    2015-04-01

    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. Retrospective reviews of clinical and radiological records. 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 the highest frequency between the age of 30 and 40. AO-type 42-A1 was the most common fracture type, representing 34% of all tibial shaft fractures. The majority of tibial shaft fractures occur during walking, indoor activity and sports. The distribution among genders shows that males present a higher frequency of fractures while participating in sports activities and walking. Women present the highest frequency of fractures while walking and during indoor activities. This study shows an incidence of 16.9/100,000/year for tibial shaft fractures. AO-type 42-A1 was the most common fracture type, representing 34% of all tibial shaft fractures. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Stress fractures in the lower extremity

    International Nuclear Information System (INIS)

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

    2007-01-01

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

  17. Incidence and epidemiology of tibial shaft fractures

    DEFF Research Database (Denmark)

    Larsen, Peter; Elsøe, Rasmus; Hansen, Sandra Hope

    2015-01-01

    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....... 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...... frequency of fractures while participating in sports activities and walking. Women present the highest frequency of fractures while walking and during indoor activities. Conclusion: This study shows an incidence of 16.9/100,000/year for tibial shaft fractures. AO-type 42-A1 was the most common fracture type...

  18. Discontinuation of denosumab and associated fracture incidence

    DEFF Research Database (Denmark)

    Brown, Jacques P; Roux, Christian; Törring, Ove

    2012-01-01

    associated with transient increases in bone remodeling and declines in bone mineral density (BMD), the effect on fracture risk during treatment cessation is not as well characterized. To understand the fracture incidence between treatment groups after cessation of investigational product, we evaluated...

  19. Stress fractures in elite cross-country athletes.

    Science.gov (United States)

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

    2007-04-01

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

  20. Upper extremity and rib stress fractures in a child

    International Nuclear Information System (INIS)

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

    1998-01-01

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

  1. Stress fractures and bone pain

    International Nuclear Information System (INIS)

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

    1984-01-01

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

  2. Computed tomography of stress fracture

    International Nuclear Information System (INIS)

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

    1982-01-01

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

  3. Computed tomography of stress fracture

    International Nuclear Information System (INIS)

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

    1982-01-01

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

  4. STRESS FRACTURE PREVALENCE IN ELITE FIGURE SKATERS

    Directory of Open Access Journals (Sweden)

    Sanda Dubravcic-Simunjak

    2008-09-01

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

  5. Risk factors for stress fractures.

    Science.gov (United States)

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

    1999-08-01

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

  6. Stress Fractures of the Foot.

    Science.gov (United States)

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

    2015-10-01

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

  7. Pedicular stress fracture in the lumbar spine

    International Nuclear Information System (INIS)

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

    1997-01-01

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

  8. Pedicular stress fracture in the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

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

    1997-08-01

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

  9. Higher incidence of hip fracture in newly diagnosed schizophrenic ...

    African Journals Online (AJOL)

    Higher incidence of hip fracture in newly diagnosed schizophrenic patients in Taiwan. Hip fracture is a major public health concern due to its poor outcome and serious socioeconomic burden in older people (1). Evidence has shown that many factors are related to increased risk of hip fracture, but psychiatric diseases are ...

  10. Distinguishing stress fractures from pathologic fractures: a multimodality approach

    International Nuclear Information System (INIS)

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

    2005-01-01

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

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

    International Nuclear Information System (INIS)

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

    1984-01-01

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

  12. Phalangeal bone mineral density predicts incident fractures

    DEFF Research Database (Denmark)

    Friis-Holmberg, Teresa; Brixen, Kim; Rubin, Katrine Hass

    2012-01-01

    This prospective study investigates the use of phalangeal bone mineral density (BMD) in predicting fractures in a cohort (15,542) who underwent a BMD scan. In both women and men, a decrease in BMD was associated with an increased risk of fracture when adjusted for age and prevalent fractures...

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

    Science.gov (United States)

    Milgrom, Charles; Finestone, Aharon S

    2017-10-01

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

  14. Clavicle fractures - incidence of supraclavicular nerve injury

    Directory of Open Access Journals (Sweden)

    Pedro Jose Labronici

    2013-08-01

    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.

  15. Increasing incidence of hip fracture in Chiang Mai, Thailand.

    Science.gov (United States)

    Wongtriratanachai, Prasit; Luevitoonvechkij, Sirichai; Songpatanasilp, Thawee; Sribunditkul, Siripoj; Leerapun, Taninnit; Phadungkiat, Sompant; Rojanasthien, Sattaya

    2013-01-01

    Hip fracture is a major health problem in Thailand. This study attempted to examine the incidence, related factors, and trends of hip fracture in Chiang Mai, Thailand. All hip fracture data among patients aged 50 yr or older were collected from hospitals in Chiang Mai, Thailand from August 1, 2006 to July 3, 2007. Data from the 1997 Chiang Mai hip fracture study were used for comparison. In the study period, 690 hip fractures were reported: 203 males and 487 females (male to female ratio was 1 to 2.4), with a mean age of 76.7 yr. The estimated cumulative incidence was 181.0 per 100,000, and the adjusted incidence was 253.3 (males: 135.9; females: 367.9). A simple fall was the most common mechanism (79%) of fracture, and 80% of the hip fractures occurred in patients aged 70 yr or older. The highest incidence of hip fracture was observed in patients older than 85 yr (1239). At 6 mo postfracture, most patients (61%) used a walking aid. Compared with the 1997 data, hip fracture incidence had increased by an average of 2% per yr, and the incidence of hip fracture had increased significantly from August 1, 2006 to July 31, 2007, especially in patients older than 75 yr. In patients older than 84 yr, the incidence increased by a factor of 2. Urgent strategies for the prevention and treatment of osteoporosis, and hence hip fracture, are needed. Copyright © 2013 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

  16. Stress fractures of the femora in soldiers

    International Nuclear Information System (INIS)

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

    1981-01-01

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

  17. Stress fractures of the femora in soldiers

    Energy Technology Data Exchange (ETDEWEB)

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

    1981-05-01

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

  18. Longitudinal stress fracture of the tibia

    International Nuclear Information System (INIS)

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

    1997-01-01

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

  19. Predictors of incident depression after hip fracture surgery.

    NARCIS (Netherlands)

    Oude Voshaar, R.C.; Banerjee, S.; Horan, M.; Baldwin, R.; Pendleton, N.; Proctor, R.; Tarrier, N.; Woodward, Y.; Burns, A.

    2007-01-01

    OBJECTIVE: Depression after hip fracture surgery is prevalent and associated with increased mortality rates and impaired functional recovery. The incidence of new-onset depressive symptoms in patients initially not depressed after hip fracture surgery and their relationship with functional recovery

  20. Stress fractures of the foot and ankle.

    Science.gov (United States)

    Welck, M J; Hayes, T; Pastides, P; Khan, W; Rudge, B

    2017-08-01

    Stress fractures occur as a result of microscopic injuries sustained when bone is subjected to repeated submaximal stresses. Overtime, with repeated cycles of loading, accumulation of such injuries can lead to macro-structural failure and frank fracture. There are numerous stress fractures about the foot and ankle of which a trauma and orthopaedic surgeon should be aware. These include: metatarsal, tibia, calcaneus, navicular, fibula, talus, medial malleolus, sesamoid, cuneiform and cuboid. Awareness of these fractures is important as the diagnosis is frequently missed and appropriate treatment delayed. Late identification can be associated with protracted pain and disability, and may predispose to non-union and therefore necessitate operative intervention. This article outlines the epidemiology and risk factors, aetiology, presentation and management of the range of stress fractures in the foot and ankle. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

    OpenAIRE

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

    2014-01-01

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

  2. Worldwide prevalence and incidence of osteoporotic vertebral fractures.

    Science.gov (United States)

    Ballane, G; Cauley, J A; Luckey, M M; El-Hajj Fuleihan, G

    2017-05-01

    We investigated the prevalence and incidence of vertebral fractures worldwide. We used a systematic Medline search current to 2015 and updated as per authors' libraries. A total of 62 articles of fair to good quality and comparable methods for vertebral fracture identification were considered. The prevalence of morphometric vertebral fractures in European women is highest in Scandinavia (26%) and lowest in Eastern Europe (18%). Prevalence rates in North America (NA) for White women ≥50 are 20-24%, with a White/Black ratio of 1.6. Rates in women ≥50 years in Latin America are overall lower than Europe and NA (11-19%). In Asia, rates in women above ≥65 are highest in Japan (24%), lowest in Indonesia (9%), and in the Middle East, Lebanon, rates are 20%. The highest-lowest ratio between countries, within and across continents, varied from 1.4-2.6. Incidence data is less abundant and more heterogeneous. Age-standardized rates in studies combining hospitalized and ambulatory vertebral fractures are highest in South Korea, USA, and Hong Kong and lowest in the UK. Neither a North-South gradient nor a relation to urbanization is evident. Conversely, the incidence of hospitalized vertebral fractures in European patients ≥50 shows a North-South gradient with 3-3.7-fold variability. In the USA, rates in Whites are approximately 4-fold higher than in Blacks. Vertebral fractures variation worldwide is lower than observed with hip fractures, and some of highest rates are unexpectedly from Asia. Better quality representative studies are needed. We investigate the occurrence of vertebral fractures, worldwide, using published data current until the present. Worldwide, the variation in vertebral fractures is lower than observed for hip fractures. Some of the highest rates are from North America and unexpectedly Asia. The highest-lowest ratio between countries, within and across continents, varied from 1.4-2.6. Better quality representative data is needed.

  3. Stress fractures: definition, diagnosis and treatment ?

    OpenAIRE

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

    2015-01-01

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

  4. Incidence and socioeconomic burden of hip fractures in Italy

    Directory of Open Access Journals (Sweden)

    A. Angeli

    2011-09-01

    Full Text Available Objectives: The aim of this study was to evaluate the trend of the incidence and costs of hip fractures in Italy. Methods: The incidence of hip fractures after 45 years of age in both females and males during the years 1999-2002 was obtained by analyzing the Italian Ministry of Health national hospitalization database, according to the diagnosis codes of International Classification of Diseases, Clinical Modification, 9° edition (IDC-9-CM that indicate femoral fracture. We have computed all direct costs sustained by the National Health Service for hospitalization and treatment of hip fractures on the basis of the value of the Diagnosis Related Groups (DRG referring to hip fractures. The expenses of rehabilitation and indirect expenses were based on estimates. Results: In 2002, more than 86,000 hip fractures were registered in Italy in male and female patients over 45 years old, with 9% progression compared to 1999; 77% were female and 80% were over 75 years of age. In 2002 the direct costs of hospitalization, in the patients over 65 years alone, were almost 400 milion euros, with an increase of 15% as compared to 1999. Considering also estimated rehabilitation costs, social aid and indirect costs, we estimate that hip fractures due to age-related osteoporosis created over a billion euros in expenses in 2002. Conclusions: Preventive intervention regarding the risk of hip fracture in elderly patients is urgent.

  5. Spontaneous stress fractures of the femoral neck

    International Nuclear Information System (INIS)

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

    1985-01-01

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

  6. 78 FR 38878 - Critical Incident Stress Plans

    Science.gov (United States)

    2013-06-28

    ... Institute (API); American Public Transportation Association (APTA); American Short Line and Regional...-0131, Notice No. 1] RIN 2130-AC00 Critical Incident Stress Plans AGENCY: Federal Railroad... incident stress plans that provide for appropriate support services to be offered to their employees who...

  7. Rare stress fracture: longitudinal fracture of the femur.

    Science.gov (United States)

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

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

  8. Hip fracture incidence is decreasing in the high incidence area of Oslo, Norway.

    Science.gov (United States)

    Støen, R O; Nordsletten, L; Meyer, H E; Frihagen, J F; Falch, J A; Lofthus, C M

    2012-10-01

    This study reports a significant decrease in age-adjusted incidence rates of hip fracture for women in Oslo, Norway, even compared with data from 1978/1979. Use of bisphosphonate may explain up to one third of the decline in the incidence. The aims of the present study were to report the current incidence of hip fractures in Oslo and to estimate the influence of bisphosphonates on the current incidence. Using the electronic diagnosis registers and lists from the operating theaters of the hospitals of Oslo, all patients with ICD-10 codes S72.0 and S72.1 (hip fracture) in 2007 were identified. Medical records of all identified patients were reviewed to verify the diagnosis. Age- and gender-specific annual incidence rates were calculated using the population of Oslo on January 1, 2007 as the population at risk. Data on the use of bisphosphonates were obtained from official registers. A total number of 1,005 hip fractures, 712 (71%) in women, were included. The age-adjusted fracture rates per 10,000 for the age group >50 years were 82.0 for women and 39.1 for men in 2007, compared with 110.8 and 41.4 in 1996/1997, 116.5 and 42.9 in 1988/1989, and 97.5 and 34.5 in 1978/1979, respectively. It was estimated that the use of bisphosphonates may explain up to 13% of the decline in incidence in women aged 60-69 years and up to 34% in women aged 70-79 years. The incidence of hip fractures in women in Oslo has decreased significantly during the last decade and is now at a lower level than in 1978/1979. This reduction was not evident in men. The incidence of hip fractures in Oslo is, however, still the highest in the world.

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

    Science.gov (United States)

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

    2014-01-01

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

  10. The radiological diagnosis of stress fracture

    International Nuclear Information System (INIS)

    Li Yonggang; Wang Renfa; Zhang Jingfeng; Wang Min

    2005-01-01

    Objective: To study the radiological features and biomechanics of stress fracture. Methods: The X-ray, CT, MRI, and ECT signs in 20 cases of stress fracture and its correlation to biomechanics were analyzed. Results: Of the 20 cases, 14 cases occurred in the tibia, 2 cases in the metatarsal bone, 1 case in the rib, 1 case in the neck of femur and ribs, 1 case in the middle-inferior part of the femur, and 1 case in the fibula. Tow early cases of stress fracture demonstrated a characteristic sign of 'gray cortex'. The spherical or abnormal generation of bony callus and periosteum proliferation that demonstrated 'double cortex' sign in 2 cases were the sign of bone remodeling and the 'button sign' was the sign of bone healing. CT scan could clearly show the pathologic changes of bone and the soft tissue edema. Bone callus showed low signal on T 1 WI and slight high signal on T 2 WI. The area of bone edema on MRI that demonstrated low signal on T 1 WI and high signal on T 2 WI was larger than that on CT. MRI showed a linear band of low signal on both T 1 WI and T 2 WI in the area of bone fracture. ECT showed a focal area of increased uptake in the abnormal areas. The areas of bone stress fracture were characteristic and accorded with the biomechanical weak area in the bone. Conclusion: Stress fracture occurs in the special parts of the bone and has characteristic imaging features. X-ray should still be used to find the fracture of bones in the first inspection. CT and MRI are very helpful in the differentiation. Although sensitive, bone scan has lower specificity than either CT or MRI. (authors)

  11. Drinking water fluoridation: bone mineral density and hip fracture incidence.

    Science.gov (United States)

    Lehmann, R; Wapniarz, M; Hofmann, B; Pieper, B; Haubitz, I; Allolio, B

    1998-03-01

    The role of drinking water fluoride content for prevention of osteoporosis remains controversial. Therefore, we analyzed the influence of drinking water fluoridation on the incidence of osteoporotic hip fractures and bone mineral density (BMD) in two different communities in eastern Germany: in Chemnitz, drinking water was fluoridated (1 mg/L) over a period of 30 years; in Halle, the water was not fluoridated. BMD was measured in healthy hospital employees aged 20-60 years (Halle: 214 women, 98 men; Chemnitz: 201 women, 43 men, respectively) using dual-energy X-ray absorptiometry. Hip fractures in patients > or = 35 years admitted to the local hospitals in the years 1987-1989 were collected from the clinic registers. There was no difference in age, anthropometric, hormonal, or lifestyle variables between the two groups. Mean fluoride exposure in Chemnitz was 25.2 +/- 7.3 years. No correlation was found between fluoride exposure and age-adjusted BMD. We found no significant difference in spinal or femoral BMD between subjects living in Halle and Chemnitz [lumbar spine: 0.997 +/- 0.129 (g/cm2) vs. 1.045 + 0.171 (g/cm2), p = 0.08, for men; 1.055 +/- 0.112 (g/cm2) vs. 1.046 +/- 0.117 (g/cm2), p = 0.47, for women]. The fracture incidence showed an exponential increase with aging in men and women with an incidence about 3.5 times higher for women. In Chemnitz, we calculated an age-adjusted annual incidence of 142.2 per 100,000 for women and 72.5 per 100,000 for men, respectively. In Halle, the incidences were 178.5 per 100,000 for women and 89.2 per 100,000 for men. There was a lower hip fracture incidence after the age of 85 in women in Chemnitz (1391 per 100,000 in Chemnitz vs. 1957 per 100,000) in Halle, p = 0.006). Using the age-adjusted incidences, significantly fewer hip fractures occurred in Chemnitz in both men and women. In conclusion, our study suggests that optimal drinking water fluoridation (1 mg/L), which is advocated for prevention of dental caries, does

  12. Bone stress in runners with tibial stress fracture.

    Science.gov (United States)

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

    2015-11-01

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

  13. Acoustic Emission Based Surveillance System for Prediction of Stress Fractures

    Science.gov (United States)

    2007-09-01

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

  14. Stress fractures: definition, diagnosis and treatment.

    Science.gov (United States)

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

    2016-01-01

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

  15. Changing incidence and residual lifetime risk of common osteoporosis-related fractures

    DEFF Research Database (Denmark)

    Lauritzen, J B; Schwarz, Peter; Lund, B

    1993-01-01

    1735 fractures of the distal radius, 747 fractures of the proximal humerus, 878 cervical and 635 trochanteric hip fractures were included. In men 273 cervical and 232 trochanteric hip fractures were included. The fractures were registered during the period 1976 to 1984 and changes in age.......05) during the observation period, while no significant decrease was found in the incidence of trochanteric fractures. No significant changes in incidence were observed in women with radial or humeral fractures, or in men with hip fractures. A women 60 years old with a life expectancy of 81 years had......Changes in incidence and lifetime risk of fractures are of major importance in the epidemiology of osteoporosis. We focused on hip fractures in women and men and on radial and humeral fractures in women. The study subjects comprised 4500 women and men 20 years old or more with fractures. In women...

  16. Incidence of Symptomatic Vertebral Fractures in Patients After Percutaneous Vertebroplasty

    International Nuclear Information System (INIS)

    Hierholzer, Johannes; Fuchs, Heiko; Westphalen, Kerstin; Baumann, Clemens; Slotosch, Christine; Schulz, Rudolf

    2008-01-01

    The aim of this study was to evaluate the incidence of secondary symptomatic vertebral compression fractures (VCFs) in patients previously treated by percutaneous vertebroplasty (VTP). Three hundred sixteen patients with 486 treated VCFs were included in the study according to the inclusion criteria. Patients were kept in regular follow-up using a standardized questionairre before, 1 day, 7 days, 6 months, and 1 year after, and, further on, on a yearly basis after VTP. The incidence of secondary symptomatic VCF was calculated, and anatomical distribution with respect to previous fractures characterized. Mean follow-up was 8 months (6-56 months) after VTP. Fifty-two of 316 (16.4 %) patients (45 female, 7 male) returned for treatment of 69 secondary VCFs adjacent to (35/69; 51%) or distant from (34/69; 49%) previously treated levels. Adjacent secondary VCF occurred significantly more often compared to distant secondary VCF. Of the total 69 secondary VCFs, 35 of 69 occurred below and 27 of 69 above pretreated VCFs. Of the 65 sandwich levels generated, in 7 of 65 (11%) secondary VCFs were observed. Secondary VCF below pretreated VCF occurred significantly earlier in time compared to VCF above and compared to sandwich body fractures. No major complication occurred during initial or follow-up intervention. We conclude that secondary VCFs do occur in individuals after VTP but the rate found in our study remains below the level expected from epidemiologic studies. Adjacent fractures occur more often and follow the cluster distribution of VCF as expected from the natural history of the underlying osteoporosis. No increased rate of secondary VCF after VTP was observed in this retrospective analysis. In accordance with the pertinent literature, short-term and also midterm clinical results are encouraging and provide further support for the usefulness and the low complication rate of this procedure as an adjunct to the spectrum of pain management in patients with severe

  17. Couple stresses and the fracture of rock.

    Science.gov (United States)

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

    2015-03-28

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

  18. Stress fractures: pathophysiology, clinical presentation, imaging features, and treatment options.

    Science.gov (United States)

    Matcuk, George R; Mahanty, Scott R; Skalski, Matthew R; Patel, Dakshesh B; White, Eric A; Gottsegen, Christopher J

    2016-08-01

    Stress fracture, in its most inclusive description, includes both fatigue and insufficiency fracture. Fatigue fractures, sometimes equated with the term "stress fractures," are most common in runners and other athletes and typically occur in the lower extremities. These fractures are the result of abnormal, cyclical loading on normal bone leading to local cortical resorption and fracture. Insufficiency fractures are common in elderly populations, secondary to osteoporosis, and are typically located in and around the pelvis. They are a result of normal or traumatic loading on abnormal bone. Subchondral insufficiency fractures of the hip or knee may cause acute pain that may present in the emergency setting. Medial tibial stress syndrome is a type of stress injury of the tibia related to activity and is a clinical syndrome encompassing a range of injuries from stress edema to frank-displaced fracture. Atypical subtrochanteric femoral fracture associated with long-term bisphosphonate therapy is also a recently discovered entity that needs early recognition to prevent progression to a complete fracture. Imaging recommendations for evaluation of stress fractures include initial plain radiographs followed, if necessary, by magnetic resonance imaging (MRI), which is preferred over computed tomography (CT) and bone scintigraphy. Radiographs are the first-line modality and may reveal linear sclerosis and periosteal reaction prior to the development of a frank fracture. MRI is highly sensitive with findings ranging from periosteal edema to bone marrow and intracortical signal abnormality. Additionally, a brief description of relevant clinical management of stress fractures is included.

  19. Effect of Stress State on Fracture Features

    Science.gov (United States)

    Das, Arpan

    2018-02-01

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

  20. Fracture criteria of reactor graphite under multiaxial stresses

    International Nuclear Information System (INIS)

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

    1987-01-01

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

  1. Perimenopausal risk of falling and incidence of distal forearm fracture.

    OpenAIRE

    Winner, S. J.; Morgan, C. A.; Evans, J. G.

    1989-01-01

    A postal survey of 2000 women and 2000 men sampled from the electoral roll in Oxford was undertaken to ascertain whether changes with age in the risk of falling might explain the stepwise increases in age specific incidence rates of distal forearm fracture which occur in women at around the age of 50. Corrected response rates were 83% for women and 72% for men. In women, but not in men, there was a rise in the risk of falling from 45 years, peaking in the 55-59 year age group, and sinking to ...

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

    International Nuclear Information System (INIS)

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

    2012-01-01

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

  3. Incidence of Deformation and Fracture of Twisted File Adaptive Instruments after Repeated Clinical Use

    Directory of Open Access Journals (Sweden)

    Gianluca Gambarini

    2017-01-01

    Full Text Available Objectives: The aim of the present study was to investigate the incidence of deformation and fracture of twisted file adaptive nickel-titanium instruments after repeated clinical use and to identify and check whether the three instruments within the small/medium sequence showed similar or different visible signs of metal fatigue. Material and Methods: One-hundred twenty twisted file adaptive (TFA packs were collected after clinically used to prepare three molars and were inspected for deformations and fracture. Results: The overall incidence of deformation was 22.2%, which was not evenly distributed within the instruments: 15% for small/medium (SM1 (n = 18, 38.33% for SM2 (n = 46 and 13.33% for the SM3 instruments (n = 16. The defect rate of SM2 instruments was statistically higher than the other two (P < 0.001. The fracture rate was 0.83% (n = 3, being two SM2 instruments and one SM3. Conclusions: It was observed a very low defect rate after clinical use of twisted file adaptive rotary instruments. The untwisting of flutes was significantly more frequent than fracture, which might act as prevention for breakage. The results highlight the fact that clinicians should be aware that instruments within a sequence might be differently subjected to intracanal stress.

  4. Atypical stress-avulsion fracture of the Lisfranc joint complex.

    LENUS (Irish Health Repository)

    O'Neill, Barry J

    2014-04-01

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

  5. Incidence of fractures in patients with multiple sclerosis: the Danish National Health Registers

    DEFF Research Database (Denmark)

    Bazelier, Marloes T; de Vries, Frank; Bentzen, Joan

    2012-01-01

    Background: Patients with multiple sclerosis (MS) are potentially at high risk of fracture due to falls and osteoporosis. Objective: To estimate incidence rates of fractures in MS patients, stratified by fracture type, sex and age, and to compare these rates with controls. Methods: The case...... population consisted of all patients with an accepted diagnosis of MS in the Danish MS Registry (1949-2007). Data were linked to the National Hospital Discharge Register (1977-2007). Patients with MS (n = 11,157) were 1: 6 matched by year of birth, gender, calendar time and region to persons without MS...... (controls). Incidence rates of fracture were estimated as the number of fractures per 1000 person-years. Incidence rate ratios (IRRs) were calculated by dividing fracture rates in MS patients by fracture rates in controls. Results: Among patients with MS, the incidence rate of any fracture yielded 22.8 per...

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

    International Nuclear Information System (INIS)

    Abel, M.S.

    1985-01-01

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

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

    International Nuclear Information System (INIS)

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

    2005-01-01

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

  8. Trochanteric Stress Fracture in a Female Window Cleaner

    OpenAIRE

    Lee, Bong-Jin; Song, Jyewon

    2016-01-01

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

  9. Impact of a community-based osteoporosis and fall prevention program on fracture incidence.

    Science.gov (United States)

    Grahn Kronhed, Ann-Charlotte; Blomberg, Carina; Karlsson, Nadine; Löfman, Owe; Timpka, Toomas; Möller, Margareta

    2005-06-01

    Associations between a 10-year community-based osteoporosis and fall prevention program and fracture incidence amongst middle-aged and elderly residents in an intervention community are studied, and comparisons are made with a control community. A health-education program was provided to all residents in the intervention community, which addressed dietary intake, physical activity, smoking habits and environmental risk factors for osteoporosis and falls. Both communities are small, semi-rural and situated in Ostergotland County in southern Sweden. The analysis is based on incidences of forearm fractures in the population 40 years of age or older, and hip fractures in the population 50 years of age or older. Data for three 5-year periods (pre-, early and late intervention) are accumulated and compared. In the intervention community, forearm fracture incidence decreased in women. There are also tendencies towards decreasing forearm fracture incidence in men, and towards decreasing trochanteric hip fracture incidences in women and in men in the late intervention period. No such changes in fracture incidences are found in the control community. Cervical hip fracture incidence did not change in the intervention and the control communities. Although the reported numbers of fractures are small (a total of 451 forearm and 357 hip fractures), the numbers are based on total community populations and thus represent a true difference. The decrease in forearm fracture incidence among women, and the tendency towards decreasing trochanteric hip fractures, in contrast to the absence of change in cervical hip fractures, might be mainly due to a more rapid effect of fall preventive measures than an increase in bone strength in the population. For the younger age groups an expected time lag between intervention and effect might invalidate the short follow-up period for outcome measurements. Thus, the effect of the 10-year intervention program on fracture incidence should be followed

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

    Science.gov (United States)

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

    2012-03-01

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

  11. Anomalous Transport in Natural Fracture Networks Induced by Tectonic Stress

    Science.gov (United States)

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

    2017-12-01

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

  12. High fall incidence and fracture rate in elderly dialysis patients.

    Science.gov (United States)

    Polinder-Bos, H A; Emmelot-Vonk, M H; Gansevoort, R T; Diepenbroek, A; Gaillard, C A J M

    2014-12-01

    Although it is recognised that the dialysis population is ageing rapidly, geriatric complications such as falls are poorly appreciated, despite the many risk factors for falls in this population. The objective of this study was to determine the incidence, complications and risk factors for falls in an elderly dialysis population. A one-year observational study of chronic dialysis patients aged ≥ 70 years. At baseline, patient characteristics were noted and during follow-up the vital parameters and laboratory values were recorded. Patients were questioned weekly about falls, fall circumstances and consequences by trained nurses. 49 patients were included with a median age of 79.3 years (70-89 years). During follow-up 40 fall accidents occurred in 27 (55%) patients. Falls resulted in fractures in 15% of cases and in hospital admissions in 15%. In haemodialysis (HD) patients, the mean systolic blood pressure (SBP) before HD was lower in fallers compared with non-fallers (130 vs. 143 mmHg). Several patients in the lower blood pressure category received antihypertensive medication. For every 5 mmHg lower SBP (before HD) the fall risk increased by 30% (hazard ratio (HR) 1.30, 95% CI 1.03-1.65, p = 0.03). Furthermore, fall risk increased by 22% for every 10 pmol/l rise of parathyroid hormone (HR 1.22, 95% CI 1.06-1.39, p = 0.004). Elderly dialysis patients have a high incidence of falls accompanied by a high fracture rate. Given the high complication rate, elderly patients at risk of falling should be identified and managed. Reduction of blood pressure-lowering medication might be a treatment strategy to reduce falls.

  13. Spartan Release Engagement Mechanism (REM) stress and fracture analysis

    Science.gov (United States)

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

    1984-01-01

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

  14. NextGen Stress & Fracture for Lightweight Structures

    Data.gov (United States)

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

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

    Directory of Open Access Journals (Sweden)

    T. Hetling

    2016-01-01

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

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

    International Nuclear Information System (INIS)

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

    2000-01-01

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

  17. CANDIDATE GENE ANALYSIS IN ISRAELI SOLDIERS WITH STRESS FRACTURES

    Directory of Open Access Journals (Sweden)

    Ran Yanovich

    2012-03-01

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

  18. Sternal stress fracture in a gymnast: A case report and literature review

    African Journals Online (AJOL)

    There is a high incidence of injuries among gymnasts.1 This is not surprising given the ... stress fracture. A common example of poor posture in gymnasts is excessive ... Dimakatso Althea Ramagole (MB ChB, MSc (Sports Med)). Dina Christina ...

  19. Scapula fracture incidence in reverse total shoulder arthroplasty using screws above or below metaglene central cage: clinical and biomechanical outcomes.

    Science.gov (United States)

    Kennon, Justin C; Lu, Caroline; McGee-Lawrence, Meghan E; Crosby, Lynn A

    2017-06-01

    Reverse total shoulder arthroplasty (RTSA) is a viable treatment option for rotator cuff tear arthropathy but carries a complication risk of scapular fracture. We hypothesized that using screws above the central glenoid axis for metaglene fixation creates a stress riser contributing to increased scapula fracture incidence. Clinical type III scapular fracture incidence was determined with screw placement correlation: superior screw vs. screws placed exclusively below the glenoid midpoint. Cadaveric RTSA biomechanical modeling was employed to analyze scapular fractures. We reviewed 318 single-surgeon single-implant RTSAs with screw correlation to identify type III scapular fractures. Seventeen cadaveric scapula specimens were matched for bone mineral density, metaglenes implanted, and fixation with 2 screw configurations: inferior screws alone (group 1 INF ) vs. inferior screws with one additional superior screw (group 2 SUP ). Biomechanical load to failure was analyzed. Of 206 patients, 9 (4.4%) from the superior screw group experienced scapula fractures (type III); 0 fractures (0/112; 0%) were identified in the inferior screw group. Biomechanically, superior screw constructs (group 2 SUP ) demonstrated significantly (P < .05) lower load to failure (1077 N vs. 1970 N) compared with constructs with no superior screws (group 1 INF ). There was no significant age or bone mineral density discrepancy. Clinical scapular fracture incidence significantly decreased (P < .05) for patients with no screws placed above the central cage compared with patients with superior metaglene screws. Biomechanical modeling demonstrates significant construct compromise when screws are used above the central cage, fracturing at nearly half the ultimate load of the inferior screw constructs. We recommend use of inferior screws, all positioned below the central glenoid axis, unless necessary to stabilize the metaglene construct. Copyright © 2016 Journal of Shoulder and Elbow Surgery

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

    Science.gov (United States)

    Ozdemir, Guzelali; Azboy, Ibrahim; Yilmaz, Baris

    2016-01-01

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

  1. Bilateral femoral supracondylar stress fractures in a cross country runner.

    Science.gov (United States)

    Ross, Kate; Fahey, Mark

    2008-08-01

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

  2. High-Risk Stress Fractures: Diagnosis and Management.

    Science.gov (United States)

    McInnis, Kelly C; Ramey, Lindsay N

    2016-03-01

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

  3. OCCURRENCE AND INCIDENCE OF THE 2ND HIP FRACTURE

    DEFF Research Database (Denmark)

    SCHRODER, HM; Petersen, KK; ERLANDSEN, M

    1993-01-01

    % of the trochanteric fractures were preceded by a contra-lateral fracture of the same type. The mean interval between fractures was 3.3 years, and there was no significant difference between genders or among fracture types. The risk of the first fracture was 1.6 per 1000 men per year and 3.6 per 1000 women......During a 16-year period, 256 second hip fractures were found in 3898 persons 40 years of age and older who had a previous hip fracture. Ninety-two percent of the second fractures were contra-lateral, and 68% of these were the same type as the first. Thus, 62% of the femoral neck and 72......, and for the second fracture 15 per 1000 men per year and 22 per 1000 women. This increase was highly significant for both genders, especially for men....

  4. Postpartum Sacral Stress Fracture: An Atypical Case Report

    Directory of Open Access Journals (Sweden)

    Andrea Speziali

    2015-01-01

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

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

    Science.gov (United States)

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

    2017-02-01

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

  6. The risk of fracture in incident multiple sclerosis patients

    DEFF Research Database (Denmark)

    Bazelier, Marloes T; Bentzen, Joan; Vestergaard, Peter

    2012-01-01

    Patients with multiple sclerosis (MS) may be at increased risk of fractures owing to osteoporosis and falling.......Patients with multiple sclerosis (MS) may be at increased risk of fractures owing to osteoporosis and falling....

  7. Stress fractures about the tibia, foot, and ankle.

    Science.gov (United States)

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

    2012-03-01

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

  8. Case report 491: Stress fracture of the right sacrum

    Energy Technology Data Exchange (ETDEWEB)

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

    1988-07-01

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

  9. Ultrasound-Diagnosed Tibia Stress Fracture: A Case Report.

    Science.gov (United States)

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

    2017-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1995-04-01

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

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

    International Nuclear Information System (INIS)

    Mulligan, M.E.

    1995-01-01

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

  12. Ultrasound-Diagnosed Tibia Stress Fracture: A Case Report

    Directory of Open Access Journals (Sweden)

    Adae Amoako

    2017-04-01

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

  13. Fatigue stress fractures of the sacrum: diagnosis with MR imaging

    International Nuclear Information System (INIS)

    Ahovuo, J.A.; Vusuri, T.

    2004-01-01

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

  14. Length scale of secondary stresses in fracture and fatigue

    International Nuclear Information System (INIS)

    Dong, P.

    2008-01-01

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

  15. Neonatal clavicle fracture in cesarean delivery: incidence and risk factors.

    Science.gov (United States)

    Choi, Hyun Ah; Lee, Yeon Kyung; Ko, Sun Young; Shin, Son Moon

    2017-07-01

    Neonatal clavicle fracture in cesarean delivery is rare and has not been extensively studied. We performed a retrospective review of cesarean deliveries with neonatal clavicle fracture during a 12-year period. Maternal and neonatal factors as well as surgical factors related to cesarean delivery for the fracture were determined and compared to the control group to analyze their significance. Among a total 89 367 deliveries during the study period, 36 286 babies were born via cesarean section. Nineteen cases of clavicle fractures in cesarean section were identified (0.05% of total live births via cesarean section). In the analysis of maternal and neonatal risk factors, birthweight, birthweight ≥ 4000  g and maternal age were significantly associated with clavicle fracture in cesarean section. However, clavicle fractures were not correlated with the selected surgical factors such as indication for cesarean section, skin incision to delivery time and incision type of skin and uterus. Logistic regression analysis showed that birthweight was the major risk factor for clavicle fracture. Clavicle fractures complicated 0.05% of cesarean deliveries. The main risk factor related to a clavicle fracture in cesarean section was the birthweight of an infant. As reported in previous studies associated with vaginal delivery, clavicle fracture is considered to be an unavoidable event and may not be eliminated, even in cesarean delivery.

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

    LENUS (Irish Health Repository)

    2012-02-01

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

  17. Change in the use of hormone replacement therapy and the incidence of fracture in Oslo.

    Science.gov (United States)

    Meyer, H E; Lofthus, C M; Søgaard, A J; Falch, J A

    2009-05-01

    Fracture incidence in Oslo decreased from the 1970s to the 1990s in younger postmenopausal women, but not in older women or in men. Concurrently, hormone replacement therapy increased considerably. Using data from the Oslo Health Study, we estimated that roughly half the decline might be attributed hormone replacement therapy. Between the late 1970s and the late 1990s, the incidence of hip fracture and distal forearm fracture decreased in younger postmenopausal women in Oslo, but not in elderly women or in men. The purpose of this report is to evaluate whether the decreased incidence was coherent with trends in use of hormone replacement therapy (HRT). Data on estrogens were collected from official drug statistics, data on fractures from published studies and data on bone mineral density (BMD) from the Oslo Health Study. The sale of all estrogens increased 22 times from 1979 to 1999, and the sub-category estradiol combined with progestin increased 35 times. In the corresponding period the incidence of distal forearm fracture in women aged 50-64 years decreased by 33% and hip fracture by 39%. Based on differences in BMD between users and non-users of HRT, we estimated that up to half of this decline might be due to HRT. The reduction in fracture incidence in postmenopausal women in Oslo occurred in a period with a substantial increase in the use of HRT. Future surveillance will reveal whether the last years' decline in use of HRT will be translated into increasing fracture rates.

  18. Stress fracture development classified by bone scintigraphy

    International Nuclear Information System (INIS)

    Zwas, S.T.; Elkanovich, R.; Frank, G.; Aharonson, Z.

    1985-01-01

    There is no consensus on classifying stress fractures (SF) appearing on bone scans. The authors present a system of classification based on grading the severity and development of bone lesions by visual inspection, according to three main scintigraphic criteria: focality and size, intensity of uptake compare to adjacent bone, and local medular extension. Four grades of development (I-IV) were ranked, ranging from ill defined slightly increased cortical uptake to well defined regions with markedly increased uptake extending transversely bicortically. 310 male subjects aged 19-2, suffering several weeks from leg pains occurring during intensive physical training underwent bone scans of the pelvis and lower extremities using Tc-99-m-MDP. 76% of the scans were positive with 354 lesions, of which 88% were in th4e mild (I-II) grades and 12% in the moderate (III) and severe (IV) grades. Post-treatment scans were obtained in 65 cases having 78 lesions during 1- to 6-month intervals. Complete resolution was found after 1-2 months in 36% of the mild lesions but in only 12% of the moderate and severe ones, and after 3-6 months in 55% of the mild lesions and 15% of the severe ones. 75% of the moderate and severe lesions showed residual uptake in various stages throughout the follow-up period. Early recognition and treatment of mild SF lesions in this study prevented protracted disability and progression of the lesions and facilitated complete healing

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

    Science.gov (United States)

    Sutton, John R.; Nilson, Karen L.

    1989-01-01

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

  20. Clinical evaluation of stress fractures using bone scintigraphy

    International Nuclear Information System (INIS)

    Furuta, Atsuhiko; Tanohata, Kazunori; Otake, Toru; Hashizume, Toshiyuki; Kobayashi, Yozi; Nakazima, Hiroyuki.

    1984-01-01

    Clinical evaluation of stress fractures were performed in 58 athletes using bone scintigraphy with sup(99m)Tc-MDP. Stress fractures of the tibia were most often seen in the males with running type sports. They occurred more often in the proximal tibia and on the right side. Stress fractures of the fibula were most often seen in females with jumping type sports, such as volley ball. They occurred more often in the distal fibula and on the right side. Tarsal bone fractures were seen most often rugby players. Metatarsal fractures occurred in the third fourth and fifth metatarsals. No lesion was seen in the first and second metatarsals. We feel that stress fractures of the femur can be differentiated from osteosarcoma by small loculated radionuclide accumulation as well as symptome, course and tomographic and CT finding. Bilateral involvement was seen in two cases in patellae and calcanei. Most of the other fractures were seen on the right side. Negative radiographs were seen in 36% of the patients and occurred most commonly in the tarsal bones excluding calcaneus. Bone scintigrams were positive in all cases and were most useful in fractures of the tarsal bones excluding calcaneus. (author)

  1. Clinical evaluation of stress fractures using bone scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Furuta, Atsuhiko; Tanohata, Kazunori; Otake, Toru; Hashizume, Toshiyuki (Kanto Rosai Hospital, Kawasaki, Kanagawa (Japan)); Kobayashi, Yozi; Nakazima, Hiroyuki

    1984-05-01

    Clinical evaluation of stress fractures were performed in 58 athletes using bone scintigraphy with sup(99m)Tc-MDP. Stress fractures of the tibia were most often seen in the males with running type sports. They occurred more often in the proximal tibia and on the right side. Stress fractures of the fibula were most often seen in females with jumping type sports, such as volley ball. They occurred more often in the distal fibula and on the right side. Tarsal bone fractures were seen most often rugby players. Metatarsal fractures occurred in the third fourth and fifth metatarsals. No lesion was seen in the first and second metatarsals. We feel that stress fractures of the femur can be differentiated from osteosarcoma by small loculated radionuclide accumulation as well as symptoms, course and tomographic and CT findings. Bilateral involvement was seen in two cases in patellae and calcanei. Most of the other fractures were seen on the right side. Negative radiographs were seen in 36% of the patients and occurred most commonly in the tarsal bones excluding calcaneus. Bone scintigrams were positive in all cases and were most useful in fractures of the tarsal bones excluding calcaneus.

  2. Longitudinal stress fracture of the femur: A rare presentation

    International Nuclear Information System (INIS)

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

    2016-01-01

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

  3. Medial supracondylar stress fracture in an adolescent pitcher

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-01-15

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

  4. 3-D description of fracture surfaces and stress-sensitivity analysis for naturally fractured reservoirs

    Energy Technology Data Exchange (ETDEWEB)

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

    1997-08-01

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

  5. Lower thoracic rib stress fractures in baseball pitchers.

    Science.gov (United States)

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

    2016-01-01

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

  6. The incidence of associated fractures of the upper limb in fractures of the radial head

    NARCIS (Netherlands)

    Kaas, Laurens; van Riet, Roger P.; Vroemen, Jos P. A. M.; Eygendaal, Denise

    2008-01-01

    Radial head fractures are common injuries. In American publications, one-third of the patients with these fractures have been shown to have associated injuries. The aim of this retrospective study is to describe the epidemiology of radial head fractures and associated fractures of the ipsilateral

  7. Do Capacitively Coupled Electric Fields Accelerate Tibial Stress Fracture Healing

    National Research Council Canada - National Science Library

    Hoffman, Andrew

    2002-01-01

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

  8. Do Capacity Coupled Electric Fields Accelerate Tibial Stress Fracture Healing?

    National Research Council Canada - National Science Library

    Hoffman, Andrew

    2004-01-01

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

  9. Do Capacitively Coupled Electric Fields Accelerate Tibial Stress Fracture Healing

    National Research Council Canada - National Science Library

    Hoffman, Andrew

    2003-01-01

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

  10. Connection between tectonic stresses and well fracturing data

    Energy Technology Data Exchange (ETDEWEB)

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

    1961-01-01

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

  11. Stress fractures of the proximal tibia in runners

    International Nuclear Information System (INIS)

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

    1982-01-01

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

  12. Multiple stress fractures in a young female runner.

    Science.gov (United States)

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

    2004-01-01

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

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

    International Nuclear Information System (INIS)

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

    2009-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-07-15

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

  15. Incidence of spinal fractures in the Netherlands 1997-2012

    NARCIS (Netherlands)

    ten Brinke, J. G.; Saltzherr, T. P.; Panneman, M. J. M.; Hogervorst, M.; Goslings, J. C.

    2017-01-01

    : To determine time trends of emergency department (ED) visits, hospitalization rates, spinal cord lesions and characteristics of patients with spinal fractures in the Netherlands. In an observational database study we used the Dutch Injury Surveillance System to analyse spinal fracture-related ED

  16. Measurement of residual stresses using fracture mechanics weight functions

    International Nuclear Information System (INIS)

    Fan, Y.

    2000-01-01

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

  17. Measurement of residual stresses using fracture mechanics weight functions

    International Nuclear Information System (INIS)

    Fan, Y.

    2001-01-01

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

  18. Radioisotopic and Radiological Evaluation in Patient with Stress Fracture

    International Nuclear Information System (INIS)

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

    1987-01-01

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

  19. Comparing the Incidence of Falls/Fractures in Parkinson's Disease Patients in the US Population.

    Directory of Open Access Journals (Sweden)

    Linda Kalilani

    Full Text Available Patients with Parkinson's disease (PD may experience falls and/or fractures as a result of disease symptoms. There are limited data available from long-term studies estimating the incidence of falls/fractures in patients with PD. The objective was to compare the incidence rate of falls/fractures in PD patients with non-PD patients in a US population. This was a retrospective study using a US-based claims database (Truven Health MarketScan® that compared the incidence rate of falls/fractures in PD subjects with non-PD subjects. The study period included the 12 months prior to index date (defined as earliest PD diagnosis [International Classification of Diseases, Ninth Revision, Clinical Modification code 332.0] and a postindex period to the end of data availability. Fractures were defined by inpatient/outpatient claims as a principal or secondary diagnosis and accompanying procedure codes during the postindex period. Incidence rates and 95% CIs for falls/fractures were calculated as the number of events per 10,000 person-years of follow-up using negative binomial or Poisson regression models. Twenty-eight thousand two hundred and eighty PD subjects were matched to non-PD subjects for the analysis (mean [SD] age, 71.4 [11.8] years; 53% male. A higher incidence rate (adjusted for comorbidities and medications of all fall/fracture cases and by fall and fracture types was observed for PD subjects versus non-PD subjects; the overall adjusted incidence rate ratio comparing PD to non-PD subjects was 2.05; 95% CI, 1.88-2.24. The incidence rate of falls/fractures was significantly higher in subjects with PD compared with non-PD subjects in a US population.

  20. Vitamin D supplementation and fracture incidence in elderly persons : A randomized, placebo-controlled clinical trial

    NARCIS (Netherlands)

    Lips, Paul; Graafmans, Wilco C.; Ooms, Marcel E.; Bezemer, P. Dick; Bouter, Lex M.

    1996-01-01

    Objective: To determine whether vitamin D supplementation decreases the incidence of hip fractures and other peripheral bone fractures. Design: Prospective, double-blind trial. Setting: Community setting (Amsterdam and surrounding area). Patients: 2578 persons (1916 women, 662 men) 70 years of age

  1. Bilateral First Rib Stress Fractures in a Basketball Player

    Directory of Open Access Journals (Sweden)

    Abidin (Radyoloji Kilincer

    2016-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Satoshi Yamaguchi

    2017-10-01

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

  3. Influence of microporosity on fracture stress of pyrocarbon coatings

    International Nuclear Information System (INIS)

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

    1975-01-01

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

  4. Sacral Stress Fracture in an Amateur Badminton Player

    Directory of Open Access Journals (Sweden)

    Yusuke Yuasa

    2017-01-01

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

  5. Incidence and direct hospitalisation costs of hip fractures in Vilnius, capital of Lithuania, in 2010

    Directory of Open Access Journals (Sweden)

    Tamulaitiene Marija

    2012-07-01

    Full Text Available Abstract Background Few epidemiological data on hip fractures were previously available in Lithuania. The aim of this study was to estimate the incidence and hospital costs of hip fractures in Vilnius in 2010. Methods Data were collected from the medical charts of all patients admitted to hospitals in Vilnius (population, 548,835 due to new low-energy trauma hip fracture, during 2010. The estimated costs included ambulance transportation and continuous hospitalisation immediately after a fracture, which are covered by the Lithuanian healthcare system. Results The incidence of new low-energy trauma hip fractures was 252 (308 women and 160 men per 100,000 inhabitants of Vilnius aged 50-years or more. There was an exponential increase in the incidence with increasing age. The overall estimated cost of hip fractures in Vilnius was 1,114,292 EUR for the year 2010. The greatest part of the expenditure was accounted for by fractures in individuals aged 65-years and over. The mean cost per case was 2,526.74 EUR, and cost varied depending on the treatment type. Hip replacement did not affect the overall mean costs of hip fracture. The majority of costs were incurred for acute (53% and long-term care (35% hospital stays, while medical rehabilitation accounted for only 12% of the overall cost. The costs of hip fracture were somewhat lower than those found in other European countries. Conclusion The data on incidence and costs of hip fractures will help to assess the importance of interventions to reduce the number of fractures and associated costs.

  6. Rib fractures predict incident limb fractures: results from the European prospective osteoporosis study.

    Science.gov (United States)

    Ismail, A A; Silman, A J; Reeve, J; Kaptoge, S; O'Neill, T W

    2006-01-01

    Population studies suggest that rib fractures are associated with a reduction in bone mass. While much is known about the predictive risk of hip, spine and distal forearm fracture on the risk of future fracture, little is known about the impact of rib fracture. The aim of this study was to determine whether a recalled history of rib fracture was associated with an increased risk of future limb fracture. Men and women aged 50 years and over were recruited from population registers in 31 European centres for participation in a screening survey of osteoporosis (European Prospective Osteoporosis Study). Subjects were invited to complete an interviewer-administered questionnaire that included questions about previous fractures including rib fracture, the age of their first fracture and also the level of trauma. Lateral spine radiographs were performed and the presence of vertebral deformity was determined morphometrically. Following the baseline survey, subjects were followed prospectively by annual postal questionnaire to determine the occurrence of clinical fractures. The subjects included 6,344 men, with a mean age of 64.2 years, and 6,788 women, with a mean age of 63.6 years, who were followed for a median of 3 years (range 0.4-5.9 years), of whom 135 men (2.3%) and 101 women (1.6%) reported a previous low trauma rib fracture. In total, 138 men and 391 women sustained a limb fracture during follow-up. In women, after age adjustment, those with a recalled history of low trauma rib fracture had an increased risk of sustaining 'any' limb fracture [relative hazard (RH)=2.3; 95% CI 1.3, 4.0]. When stratified by fracture type the predictive risk was more marked for hip (RH=7.7; 95% CI 2.3, 25.9) and humerus fracture (RH=4.5; 95% CI 1.4, 14.6) than other sites (RH=1.6; 95% CI 0.6, 4.3). Additional adjustment for prevalent vertebral deformity and previous (non-rib) low trauma fractures at other sites slightly reduced the strength of the association between rib fracture and

  7. Physeal fractures in the horse. I. Classification and incidence

    International Nuclear Information System (INIS)

    Embertson, R.M.; Bramlage, L.R.; Herring, D.S.; Gabel, A.A.

    1986-01-01

    Seventy appendicular skeletal physeal fractures in 67 horses were reviewed and classified using the Salter-Harris classification. All the horses were less than 2 years old (mean age at injury 6.2 months). The mean age at injury for pressure physeal fractures (5.2 months) was significantly less (p < .05) than for traction physeal fractures (8.3 months). The majority (67.2%) of the horses were female. Forty-eight (69%) pressure physes and 22 (31%) traction physes were affected. The most common pressure and traction physeal fracture sites were the proximal femoral physis and the proximal ulnar physis, respectively. Sixty-seven physeal fractures were classified: 14 as Type I (20.9%), 42 as Type II (62.7%), six as Type III (8.9%), and five as Type IV (7.5%). Forty-six pressure physeal fractures were classified: six as Type I (13.0%), 30 as Type II (65.2%), five as Type Hi (10.9%), and 5 as Type IV (10.9%)

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

    Science.gov (United States)

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

    2018-01-01

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

  9. Stress generation and hierarchical fracturing in reactive systems

    Science.gov (United States)

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

    2007-12-01

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

  10. Incidence of Avascular Necrosis of the Femoral Head After Intramedullary Nailing of Femoral Shaft Fractures

    Science.gov (United States)

    Kim, Ji Wan; Oh, Jong-Keon; Byun, Young-Soo; Shon, Oog-Jin; Park, Jai Hyung; Oh, Hyoung Keun; Shon, Hyun Chul; Park, Ki Chul; Kim, Jung Jae; Lim, Seung-Jae

    2016-01-01

    Abstract The goal of this study was to determine the incidence of avascular necrosis of the femoral head (AVNFH) after intramedullary nailing of femoral shaft fractures and to identify risk factors for developing AVNFH. We retrospectively reviewed all patients with femoral shaft fractures treated with antegrade intramedullary nailing at 10 institutions. Among the 703 patients enrolled, 161 patients were excluded leaving 542 patients in the study. Average age was 42.1 years with average follow-up of 26.3 months. Patient characteristics and fracture patterns as well as entry point of femoral nails were identified and the incidence of AVNFH was investigated. Patients were divided into 2 groups according to open versus closed physis, open versus closed fractures, and age (<20 versus ≥20 years). Overall incidence of AVNFH was 0.2% (1 of 542): the patient was 15-year-old boy. Of 25 patients with open physis, the incidence of AVNFH was 4%, whereas none of 517 patients with closed physis developed AVNFH (P < 0.001). The incidence of AVNFH in patients aged < 20 versus ≥20 years was 1.1% (1 of 93) and 0.0% (0 of 449), respectively (P = 0.172), which meant that the incidence of AVNFH was 0% in adult with femur shaft fracture. Of 61 patients with open fractures, the incidence of AVNFH was 0%. The number of cases with entry point at the trochanteric fossa or tip of the greater trochanter (GT) was 324 and 218, respectively, and the incidence of AVNFH was 0.3% and 0.0%, respectively (P = 0.412). In patients aged ≥20 years with isolated femoral shaft fracture, there was no case of AVNFH following antegrade intramedullary nailing regardless of the entry point. Therefore, our findings suggest that the risk of AVNFH following antegrade femoral nailing is extremely low in adult patients. PMID:26844518

  11. Stress fracture of the medial clavicle secondary to nervous tic

    International Nuclear Information System (INIS)

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

    2004-01-01

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

  12. Rehabilitation and return to running after lower limb stress fractures.

    Science.gov (United States)

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

    2013-01-01

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

  13. Bone lesions from overload: shin splint and stress fracture

    International Nuclear Information System (INIS)

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

    2005-01-01

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

  14. Taking a holistic approach to managing difficult stress fractures.

    Science.gov (United States)

    Miller, Timothy L; Best, Thomas M

    2016-09-09

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

  15. Osteoporotic compression fracture of the thoracolumbar spine and sacral insufficiency fracture: incidence and analysis of the relationship according to the clinical factors

    International Nuclear Information System (INIS)

    Kong, Jeong Hwa; Park, Ji Sun; Ryu, Kyung Nam

    2006-01-01

    To evaluate the incidence of sacral insufficiency fracture in osteoporotic patient with compression fracture of the thoracolumbar (T-L) spine on magnetic resonance image (MRI), and to analyze the correlation of variable clinical factors and the incidence of sacral insufficiency fracture. We retrospectively reviewed 160 patients (27 men, 133 women; age range of 50 to 89 years) who underwent spinal MRI and had compression fracture of the T-L spine. Compression fractures due to trauma or tumor were excluded. We evaluated the incidence of sacral insufficiency fracture according to the patients' age, sex, number of compression fractures, and the existence of bone marrow edema pattern of compression fracture. During the same period, we evaluated the incidence of spinal compression fracture in the patients of pelvic insufficiency fracture. Out of the 160 patients who had compression fracture in the T-L spine, 17 (10.6%) had insufficiency fracture of the sacrum. Compression fracture occurred almost 5 times more frequently in women (27:133), but the incidence of sacral insufficiency fracture was 2/27 for men (7.4%) and 15/133 for women (11.3%), with no statistically significant difference (ρ = 0.80). According to age, the ratio of insufficiency fracture to compression fracture was 0% (0/23) in the 50's, 10.6% (7/66) in the 60's, 12.5% (7/56) in the 70's, and 20.0% (3/15) in the 80's. In respect of single and multiple compression fracture, the incidence of sacral insufficiency fracture was 8/65 for men (12.3%) and 9/95 for women (9.5%), showing no significant difference (ρ = 0.37). In the patients with and without compression fracture with bone marrow edema, insufficiency fracture occurred in 5/76 (6.6%) and 12/84 (14.3%), respectively. On the other hand, of the 67 patients who had pelvic insufficiency fracture, 27 (40.3%) also had spinal compression fracture. About 10% of the patients with osteoporotic compression fracture in the T/L spine also had pelvic sacral

  16. Rib fractures after percutaneous radiofrequency and microwave ablation of lung tumors: incidence and relevance.

    Science.gov (United States)

    Alexander, Erica S; Hankins, Carol A; Machan, Jason T; Healey, Terrance T; Dupuy, Damian E

    2013-03-01

    To retrospectively identify the incidence and probable risk factors for rib fractures after percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) of neoplasms in the lung and to identify complications related to these fractures. Institutional review board approval was obtained for this HIPAA-compliant retrospective study. Study population was 163 patients treated with MWA and/or RFA for 195 lung neoplasms between February 2004 and April 2010. Follow-up computed tomographic images of at least 3 months were retrospectively reviewed by board-certified radiologists to determine the presence of rib fractures. Generalized estimating equations were performed to assess the effect that patient demographics, tumor characteristics, treatment parameters, and ablation zone characteristics had on development of rib fractures. Kaplan-Meier curve was used to estimate patients' probability of rib fracture after ablation as a function of time. Clinical parameters (ie, pain in ribs or chest, organ damage caused by fractured rib) were evaluated for patients with confirmed fracture. Rib fractures in proximity to the ablation zone were found in 13.5% (22 of 163) of patients. Estimated probability of fracture was 9% at 1 year and 22% at 3 years. Women were more likely than were men to develop fracture after ablation (P = .041). Patients with tumors closer to the chest wall were more likely to develop fracture (P = .0009), as were patients with ablation zones that involved visceral pleura (P = .039). No patients with rib fractures that were apparently induced by RFA and MWA had organ injury or damage related to fracture, and 9.1% (2 of 22) of patients reported mild pain. Rib fractures were present in 13.5% of patients after percutaneous RFA and MWA of lung neoplasms. Patients who had ablations performed close to the chest wall should be monitored for rib fractures.

  17. Femoral neck stress fractures (fnsf) in military recruits

    International Nuclear Information System (INIS)

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

    2012-01-01

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

  18. Postpartum osteoporosis associated with proximal tibial stress fracture

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-02-01

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

  19. Postpartum osteoporosis associated with proximal tibial stress fracture

    International Nuclear Information System (INIS)

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

    2004-01-01

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

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

    Science.gov (United States)

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

    2010-05-01

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

  1. New model for surface fracture induced by dynamical stress

    OpenAIRE

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

    1997-01-01

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

  2. BISPHOSPHONATE INDUCED STRESS FRACTURE OF BILATERAL FEMUR: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Saidapur

    2015-08-01

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

  3. L5 radiculopathy due to sacral stress fracture

    International Nuclear Information System (INIS)

    Aylwin, Anthony; Saifuddin, Asif; Tucker, Stuart

    2003-01-01

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

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

    Science.gov (United States)

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

    2005-08-01

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

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

    Science.gov (United States)

    Sallis, R E; Jones, K

    1991-05-01

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

  6. STRESS FRACTURE OF THE ULNA IN A BREAK-DANCER

    Directory of Open Access Journals (Sweden)

    Yu-Hsu Chen

    2008-12-01

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

  7. Adherence to a Mediterranean-style diet and incident fractures: pooled analysis of observational evidence.

    Science.gov (United States)

    Kunutsor, Setor K; Laukkanen, Jari A; Whitehouse, Michael R; Blom, Ashley W

    2018-06-01

    The Mediterranean diet is associated with decreased morbidity and mortality from various chronic diseases. Adherence to a Mediterranean-style diet has been suggested to have protective effects on bone health and decreases the incidence of bone fractures, but the evidence is not clear. We conducted a systematic review and meta-analysis of available observational studies to quantify the association between adherence to a Mediterranean-style diet, as assessed by the Mediterranean Diet Score (MDS), and the risk of fractures in the general population. Relevant studies were identified in a literature search of MEDLINE, EMBASE, Web of Science, and reference lists of relevant studies to October 2016. Relative risks (RRS) with 95% confidence intervals (CIs) were aggregated using random-effects models. Five observational studies with data on 353,076 non-overlapping participants and 33,576 total fractures (including 6,881 hip fractures) were included. The pooled fully adjusted RR (95% CI) for hip fractures per 2-point increment in adherence to the MDS was 0.82 (0.71-0.96). Adherence to the MDS was not associated with the risk of any or total fractures based on pooled analysis of only two studies. Limited observational evidence supports a beneficial effect of adherence to a Mediterranean-style diet on the incidence of hip fractures. Well-designed intervention studies are needed to elucidate the relationship between adherence to a Mediterranean-style diet and the risk of adverse bone health outcomes such as fractures.

  8. incidence of occupational stress among medical radiographers

    African Journals Online (AJOL)

    Job satisfaction rating was 61.3% and anxiety level was 45.3%. This study has provided a baseline stress level and prevalence among ... theoretical terms predisposes the individual to increased ... checked, burnout ensures. Burnout is an individual's reaction to chronic stress .... neurovegetative functioning of the mental but.

  9. Correlation Between Fracture Network Properties and Stress Variability in Geological Media

    Science.gov (United States)

    Lei, Qinghua; Gao, Ke

    2018-05-01

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

  10. Stress Fractures of Tibia Treated with Ilizarov External Fixator.

    Science.gov (United States)

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

    2016-08-30

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

  11. CRITICAL INCIDENTS AND CRITICAL INCIDENT STRESS MANAGEMENT (CISM – AN EMPLOYEE ASSISTANCE PROGRAMME (EAP PERSPECTIVE

    Directory of Open Access Journals (Sweden)

    Terblanche, Lourie

    2014-04-01

    Full Text Available Employees are increasingly becoming victims of critical incidents. From a systems theory point of view, it is necessary to acknowledge the impact of critical incidents not only on the personal life of the employee, but on the workplace itself. Employees respond differently to critical incidents, which makes it even more complicated when this reaches the point of requiring therapeutic intervention. The most common response to critical incidents may be the risk of developing post-traumatic stress disorder (PTSD and/or depression. This reality requires management – through the Employee Assistance Programme (EAP – to be able to effectively deal with such critical incidents.

  12. Estimation of the controlling stress in creep fracture

    International Nuclear Information System (INIS)

    Henderson, J.; Ferguson, F.R.

    1975-01-01

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

  13. Incidence rates and trends of hip/femur fractures in five European countries

    DEFF Research Database (Denmark)

    Requena, G; Abbing-Karahagopian, V; Huerta, C

    2014-01-01

    Hip fractures represent a major public health challenge worldwide. Multinational studies using a common methodology are scarce. We aimed to estimate the incidence rates (IRs) and trends of hip/femur fractures over the period 2003-2009 in five European countries. The study was performed using seven......, P European countries. With the exception of Denmark, no decreasing trend was observed over the study period....

  14. Age-specific incidence of hip fracture in the elderly: a healthy decline.

    LENUS (Irish Health Repository)

    Green, C

    2012-02-01

    Hip fractures in the elderly are an important source of morbidity and mortality. The predicted increase in the number of hip fractures due to the increasing elderly population has not been universally observed. The purpose of this study was to examine the incidence of hip fractures over a twenty year period to determine if this rise is occurring in our region. All hip fractures from the unit over 20 years were identified. Population data for those over 65 in the catchment area of our hospital was acquired. The rate of fractures occurring each year relative to the population was determined. The results were split into age groups. There was a strong correlation between the population rise and number of fractures (p = 0.77). But there was no significant difference in the rate of fracture over time (p = 0.41). However, the average age at which fracture occurred increased by two years. In addition we show the overall trend in the rate of fractures decreases in the younger age groups and increases in the older age groups. Therefore, the predicted rapid increase in rate is not occurring. This probably reflects the strengthening of the economy in Ireland from the 1930\\'s onwards, leading to a healthier population.

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

    Science.gov (United States)

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

    2010-01-01

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

  16. Worldwide variation in hip fracture incidence weakly aligns with genetic divergence between populations.

    Science.gov (United States)

    Wallace, I J; Botigué, L R; Lin, M; Smaers, J B; Henn, B M; Grine, F E

    2016-09-01

    This study investigates the influence of genetic differentiation in determining worldwide heterogeneity in osteoporosis-related hip fracture rates. The results indicate that global variation in fracture incidence exceeds that expected on the basis of random genetic variance. Worldwide, the incidence of osteoporotic hip fractures varies considerably. This variability is believed to relate mainly to non-genetic factors. It is conceivable, however, that genetic susceptibility indeed differs across populations. Here, we present the first quantitative assessment of the effects of genetic differentiation on global variability in hip fracture rates. We investigate the observed variance in publically reported age-standardized rates of hip fracture among 28 populations from around the world relative to the expected variance given the phylogenetic relatedness of these populations. The extent to which these variances are similar constitutes a "phylogenetic signal," which was measured using the K statistic. Population genetic divergence was calculated using a robust array of genome-wide single nucleotide polymorphisms. While phylogenetic signal is maximized when K > 1, a K value of only 0.103 was detected in the combined-sex fracture rate pattern across the 28 populations, indicating that fracture rates vary more than expected based on phylogenetic relationships. When fracture rates for the sexes were analyzed separately, the degree of phylogenetic signal was also found to be small (females: K = 0.102; males: K = 0.081). The lack of a strong phylogenetic signal underscores the importance of factors other than stochastic genetic diversity in shaping worldwide heterogeneity in hip fracture incidence.

  17. INCIDENCE AND CHARACTERIZATION OF ELDERLY IN THE ORTHOPEDIC CLINIC FOR FEMUR FRACTURE, CACERES MT

    Directory of Open Access Journals (Sweden)

    Andréia Costa Ferreira

    2013-05-01

    Full Text Available Introduction:The elderly population is growing gradually in recent years, it increases theincidence of elderly people at risk of falls and hip fractures develop.Objective:To identifythe incidence and characterize elderly patients hospitalized with hip fractures in theOrthopedic Clinic of the Hospital Regional Dr º Antonio Cáceres sources.Methodology:Thisis an epidemiological, descriptive, quantitative and retrospective data collection documentbasis. The study population comprised 105.Results:It was found that the fracture of thefemur showed predominance in females, comprising 40.90% of the cases and the right lowerlimb most affected. As for location, the trochanteric fractures showed 39.04%, followed byfractures of the femoral shaftwith 27.61% of the cases. The treatment applied in 62.85% ofpatients went to surgery.Conclusion:It is concluded that the femur fracture may preclude theelderly in their daily activities.

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

    Science.gov (United States)

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

    2010-08-01

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

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

    International Nuclear Information System (INIS)

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

    1999-01-01

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

  20. Incidence of traumatic long-bone fractures requiring in-hospital management: a prospective age- and gender-specific analysis of 4890 fractures.

    Science.gov (United States)

    Meling, Terje; Harboe, Knut; Søreide, Kjetil

    2009-11-01

    Musculoskeletal trauma represents a considerable global health burden; however, reliable population-based incidence data are lacking. Thus, we prospectively investigated the age- and sex-specific incidence patterns of long-bone fractures in a defined population. A 4-year prospective study of all long-bone fractures in a defined Norwegian population was carried out. The demographic data, as well as data on fracture type and location and mode of treatment were collected using recognised classification (e.g., AO/OTA - Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association; Gustilo-Anderson (GA) for open fractures). Age- and sex-adjusted incidences were calculated using population statistics. During the study period, 4890 long-bone fractures were recorded. The overall incidence per 100,000 per year was 406 with a 95% confidence interval (95%CI) of 395-417. The age-adjusted incidence for those lower than that for those >or=16 years (427; 95%CI: 414-440). The overall male incidence (337; 95%CI: 322-355) was lower than the female (476; 95%CI: 459-493), but the male:female ratio was 2:1 among those or=50 years. The upper limb fractures had an overall incidence of 159 (95%CI: 152-166), whereas the lower limb fracture incidence was 247 (95%CI: 238-256). Open fractures occurred in 3%, with an incidence of 13 (95%CI: 11-15). Paediatric fractures were more likely to be treated conservatively with only 8% requiring internal fixation, compared to 56% internal fixation in those >or=16 years of age. An increase in the use of angular stable plates occurred during the study period. This prospectively collected study of long-bone fractures in a defined population recognises age- and gender-specific fracture patterns. Boys predominate in the younger age group for which treatment is basically conservative. In the senior population, women and operative treatment predominate.

  1. High fall incidence and fracture rate in elderly dialysis patients

    NARCIS (Netherlands)

    Polinder-Bos, H. A.; Emmelot-Vonk, M. H.; Gansevoort, R. T.; Diepenbroek, A.; Gaillard, C. A. J. M.

    2014-01-01

    Background: Although it is recognised that the dialysis population is ageing rapidly, geriatric complications such as falls are poorly appreciated, despite the many risk factors for falls in this population. The objective of this study was to determine the incidence, complications and risk factors

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

    National Research Council Canada - National Science Library

    Schaffler, Mitchell B

    2005-01-01

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

  3. An Unusual Stress Fracture in an Archer with Hypophosphatasia

    Directory of Open Access Journals (Sweden)

    Umut Yavuz

    2013-01-01

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

  4. Low bone mineral density and risk of incident fracture in HIV-infected adults.

    Science.gov (United States)

    Battalora, Linda; Buchacz, Kate; Armon, Carl; Overton, Edgar T; Hammer, John; Patel, Pragna; Chmiel, Joan S; Wood, Kathy; Bush, Timothy J; Spear, John R; Brooks, John T; Young, Benjamin

    2016-01-01

    Prevalence rates of low bone mineral density (BMD) and bone fractures are higher among HIV-infected adults compared with the general United States (US) population, but the relationship between BMD and incident fractures in HIV-infected persons has not been well described. Dual energy X-ray absorptiometry (DXA) results of the femoral neck of the hip and clinical data were obtained prospectively during 2004-2012 from participants in two HIV cohort studies. Low BMD was defined by a T-score in the interval >-2.5 to fractures, adjusted for sociodemographics, other risk factors and covariables, using multivariable proportional hazards regression. Among 1,006 participants analysed (median age 43 years [IQR 36-49], 83% male, 67% non-Hispanic white, median CD4(+) T-cell count 461 cells/mm(3) [IQR 311-658]), 36% (n=358) had osteopenia and 4% (n=37) osteoporosis; 67 had a prior fracture documented. During 4,068 person-years of observation after DXA scanning, 85 incident fractures occurred, predominantly rib/sternum (n=18), hand (n=14), foot (n=13) and wrist (n=11). In multivariable analyses, osteoporosis (adjusted hazard ratio [aHR] 4.02, 95% CI 2.02, 8.01) and current/prior tobacco use (aHR 1.59, 95% CI 1.02, 2.50) were associated with incident fracture. In this large sample of HIV-infected adults in the US, low baseline BMD was significantly associated with elevated risk of incident fracture. There is potential value of DXA screening in this population.

  5. Prevalence of osteoporosis and incidence of hip fracture in women - secular trends over 30 years

    Directory of Open Access Journals (Sweden)

    Sernbo Ingemar

    2010-03-01

    Full Text Available Abstract Background The number of hip fractures during recent decades has been reported to be increasing, partly because of an increasing proportion of elderly women in the society. However, whether changes in hip fracture annual incidence in women are attributable to secular changes in the prevalence of osteoporosis is unclear. Methods Bone mineral density was evaluated by single-photon absorptiometry at the distal radius in 456 women aged 50 years or above and living in the same city. The measurements were obtained by the same densitometer during three separate time periods: 1970-74 (n = 106, 1987-93 (n = 175 and 1998-1999 (n = 178, and the age-adjusted prevalence of osteoporosis in these three cohorts was calculated. Additionally, all hip fractures sustained in the target population of women aged 50 years or above between 1967 and 2001 were registered, whereupon the crude and the age-adjusted annual incidence of hip fractures were calculated. Results There was no significant difference in the age-adjusted prevalence of osteoporosis when the three cohorts were compared (P = 1.00. The crude annual incidence (per 10,000 women of hip fracture in the target population increased by 110% from 40 in 1967 to 84 in 2001. The overall trend in the crude incidence between 1967 and 2001 was increasing (1.58 per 10,000 women per year; 95 percent confidence interval, 1.17 to 1.99, whereas the age-adjusted incidence was stable over the same period (0.22 per 10,000 women per year; 95 percent confidence interval, -0.16 to 0.60. Conclusions The increased number of hip fracture in elderly women is more likely to be attributable to demographic changes in the population than to secular increase in the prevalence of osteoporosis.

  6. Incidence of Complex Regional Pain Syndrome I Following Foot and Ankle Fractures Using the Budapest Criteria.

    Science.gov (United States)

    Bullen, Michael; Lang, Coran; Tran, Phong

    2016-12-01

    OBJECTIVE : Fractures are a well-recognized inciting event in the development of complex regional pain syndrome. This study aimed to prospectively determine the incidence of complex regional pain syndrome following foot and ankle fractures. METHODS : A prospective study was conducted of patients presenting to two metropolitan hospitals with plain radiograph diagnosis of fractures to the foot or ankle. Patients were initially screened by phone 3 months after injury using the validated International Association for the Study of Pain Budapest criteria. Patients who fulfilled the screening criteria were then physically examined by a pain specialist to assess clinical signs as part of the Budapest criteria. RESULTS : A total of 306 consecutive eligible patients were included. One hundred and ten patients reported at least one symptom of complex regional pain syndrome; however, only three fulfilled the minimum requirements to necessitate clinical review. Of these three, only one patient fulfilled the combination of symptom and sign criteria for a positive diagnosis according to the validated Budapest criteria. The incidence of complex regional pain syndrome following foot and ankle fracture in this study was 0.3%. CONCLUSION : Although many patients may experience vasomotor, sensory, and sudomotor disturbance following a fracture to the foot and ankle, the observed incidence of complex regional pain syndrome using a prospectively collected validated criteria is significantly lower than previously published. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. Fracture mechanical treatment of bridging stresses in ceramics

    International Nuclear Information System (INIS)

    Fett, T.; Munz, D.

    1993-12-01

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

  8. Stress fracture in posterior aspect of the tibia

    International Nuclear Information System (INIS)

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

    1999-01-01

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

  9. Stress fracture in posterior aspect of the tibia

    Energy Technology Data Exchange (ETDEWEB)

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

    1999-01-01

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

  10. A decreasing trend in fall-related hip fracture incidence in Victoria, Australia.

    Science.gov (United States)

    Cassell, E; Clapperton, A

    2013-01-01

    In Victoria, Australia, the age-standardised incidence of fall-related hip fracture hospitalisations decreased significantly by 25% over the period 1998/1999-2008/2009. Significant decreases in fall-related hip fractures were observed in males and females, across all 5-year age groups, in Australian-born and overseas-born Victorians, in all socio-economic quintiles and in community-dwelling older people. The study aim was to investigate trends in the incidence of fall-related and hip fracture hospitalisations among Victorians aged 65 years and older overall and by age, gender, country of birth, socio-economic status (SES) and location of the event (home, residential care institution, etc.) over the 11-year period 1998/1999 to 2008/2009. Annual counts and age-standardised rates for fall-related hospitalisations among people aged 65 years and older were estimated using Victorian hospital admissions data. The statistical significance of changes in trends over time were analysed using a log-linear regression model of the rate data assuming a Poisson distribution of cases. Although the age-standardised incidence of fall-related hospitalisations increased significantly by 13% (95% confidence interval [CI], 9% to 18%) in Victoria, the age-standardised incidence of fall-related hip fracture hospitalisations decreased from 600/100,000 in 1998/1999 to 467/100,000 in 2008/2009 - an estimated overall reduction of 25% (95% CI, -29% to -22%). By contrast, the age-standardised incidence of fall-related hospitalisations for fractures at other body sites either increased significantly or showed no significant change. Significant decreases in fall-related hip fractures were observed in both males and females, across all 5-year age groups, in both Australian-born and overseas-born Victorians, in all socio-economic quintiles and in community-dwelling older people but not in people living in residential care facilities. Despite the downward trend in the age-standardised incidence of

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

    Science.gov (United States)

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

    2017-10-01

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

  12. Stresses, fatigue and fracture analysis in the tube sheets

    International Nuclear Information System (INIS)

    Billon, F.

    1986-05-01

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

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

    Directory of Open Access Journals (Sweden)

    Tan TJL

    2015-11-01

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

  14. The incidence of pelvic fractures with traumatic lower limb amputation in modern warfare due to improvised explosive devices.

    Science.gov (United States)

    Cross, A M; Davis, C; Penn-Barwell, J; Taylor, D M; De Mello, W F; Matthews, J J

    2014-01-01

    A frequently-seen injury pattern in current military experience is traumatic lower limb amputation as a result of improvised explosive devices (IEDs). This injury can coexist with fractures involving the pelvic ring. This study aims to assess the frequency of concomitant pelvic fracture in IED-related lower limb amputation. A retrospective analysis of the trauma charts, medical notes, and digital imaging was undertaken for all patients arriving at the Emergency Department at the UK military field hospital in Camp Bastion, Afghanistan, with a traumatic lower limb amputation in the six months between September 2009 and April 2010, in order to determine the incidence of associated pelvic ring fractures. Of 77 consecutive patients with traumatic lower limb amputations, 17 (22%) had an associated pelvic fracture (eleven with displaced pelvic ring fractures, five undisplaced fractures and one acetabular fracture). Unilateral amputees (n = 31) had a 10% incidence of associated pelvic fracture, whilst 30 % of bilateral amputees (n = 46) had a concurrent pelvic fracture. However, in bilateral, trans-femoral amputations (n = 28) the incidence of pelvic fracture was 39%. The study demonstrates a high incidence of pelvic fractures in patients with traumatic lower limb amputations, supporting the routine pre-hospital application of pelvic binders in this patient group.

  15. Linked versus unlinked hospital discharge data on hip fractures for estimating incidence and comorbidity profiles.

    Science.gov (United States)

    Vu, Trang; Day, Lesley; Finch, Caroline F

    2012-08-01

    Studies comparing internally linked (person-identifying) and unlinked (episodes of care) hospital discharge data (HDD) on hip fractures have mainly focused on incidence overestimation by unlinked HDD, but little is known about the impact of overestimation on patient profiles such as comorbidity estimates. In view of the continuing use of unlinked HDD in hip fracture research and the desire to apply research results to hip fracture prevention, we concurrently assessed the accuracy of both incidence and comorbidity estimates derived from unlinked HDD compared to those estimated from internally linked HDD. We analysed unlinked and internally linked HDD between 01 July 2005 and 30 June 2008, inclusive, from Victoria, Australia to estimate the incidence of hospital admission for fall-related hip fracture in community-dwelling older people aged 65+ years and determine the prevalence of comorbidity in patients. Community-dwelling status was defined as living in private residence, supported residential facilities or special accommodation but not in nursing homes. We defined internally linked HDD as the reference standard and calculated measures of accuracy of fall-related hip fracture incidence by unlinked HDD using standard definitions. The extent to which comorbidity prevalence estimates by unlinked HDD differed from those by the reference standard was assessed in absolute terms. The sensitivity and specificity of a standard approach for estimating fall-related hip fracture incidence using unlinked HDD (i.e. omitting records of in-hospital deaths, inter-hospital transfers and readmissions within 30 days of discharge) were 94.4% and 97.5%, respectively. The standard approach and its variants underestimated the prevalence of some comorbidities and altered their ranking. The use of more stringent selection criteria led to major improvements in all measures of accuracy as well as overall and specific comorbidity estimates. This study strongly supports the use of linked

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-03-30

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

  17. Incidence Rates of and Mortality after Hip Fracture among German Nursing Home Residents

    Directory of Open Access Journals (Sweden)

    Hannes Jacobs

    2018-02-01

    Full Text Available Little is known about hip fracture rates and post-fracture mortality among nursing home residents. This retrospective cohort study examined incidence rates (IR of and mortality after hip fracture in this population focusing on sex differences. A cohort of >127,000 residents ≥65 years, newly admitted to German nursing homes between 2010 and 2014 were used to calculate age-, sex-, care-need- and time after admission-specific IR. To determine mortality, the Kaplan-Meier-method was applied. Using Cox regression, we studied mortality and estimated time-dependent hazard ratios (HRs. For this purpose, to each person with a hip fracture, one resident without a hip fracture was matched by sex, age and care-need using risk-set sampling. 75% were women (mean age: 84.0 years. During 168,588 person-years (PY, 8537 residents with at least one hip fracture were observed. The IR for women and men were 52.9 and 42.5/1000 PY. For both sexes, IR increased with rising age and decreased with increasing care-level. IR were highest in the first months after admission and subsequently declined afterwards. The impact of hip fractures on mortality was time-dependent. Mortality of residents with hip fracture was highest in the first two months after fracture compared to those without (HR: 2.82; 95% CI 2.57–3.11 and after six months, no differences were found (HR: 1.10; 95% CI 0.98–1.22 Further research should always include analyses stratified by sex, age and time period after admission.

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

    Science.gov (United States)

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

    2015-07-01

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

  19. Oncogenic osteomalacia presenting as bilateral stress fractures of the tibia

    Energy Technology Data Exchange (ETDEWEB)

    Ohashi, Kenjirou; Ohnishi, Takeshi; Ishikawa, Tohru [Department of Radiology, St. Marianna University Hospital, Kanagawa (Japan); Tani, Haruo [Department of Internal Medicine III, St. Marianna University Hospital, Kawasaki City, Kanagawa (Japan); Uesugi, Keisuke [Department of Otolaryngology, St. Marianna University Hospital, Kawasaki City, Kanagawa (Japan); Takagi, Masayuki [Department of Pathology, St. Marianna University Hospital, Kawasaki City, Kanagawa (Japan)

    1999-01-01

    We report on a patient with bilateral stress fractures of the tibia who subsequently showed classic biochemical features of oncogenic osteomalacia. Conventional radiographs were normal. MR imaging revealed symmetric, bilateral, band-like low-signal lesions perpendicular to the medial cortex of the tibiae and corresponding to the only lesions subsequently seen on the bone scan. A maxillary sinus lesion was subsequently detected and surgically removed resulting in prompt alleviation of symptoms and normalization of hypophosphatemia and low 1,25-(OH){sub 2} vitamin D{sub 3}. The lesion was pathologically diagnosed as a hemangiopericytoma-like tumor. Patients with oncogenic osteomalacia may present with stress fractures limited to the tibia, as seen in athletes. The clue to the real diagnosis lies in paying close attention to the serum phosphate levels, especially in patients suffering generalized symptoms of weakness and not given to unusual physical activity. (orig.) With 4 figs., 6 refs.

  20. Oncogenic osteomalacia presenting as bilateral stress fractures of the tibia

    International Nuclear Information System (INIS)

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

    1999-01-01

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

  1. The treatment of residual stress in fracture assessment of pressure vessels

    International Nuclear Information System (INIS)

    Green, D.; Knowles, J.

    1992-01-01

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

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

    Science.gov (United States)

    2006-12-01

    MRI confirmed a large coexisting haemangioma which may have confounded perception of stress fracture symptoms. Table 1 is a comprehensive subject...Johnson JR, Light KI, Yuan HA: A double-blind study of capacitively coupled electrical stimulation as an adjunct to lumbar spinal fusions. Spine 24...Simmons JW, Jr., Mooney V, Thacker I: Pseudarthrosis after lumbar spine fusion: nonoperative salvage with pulsed electromagnetic fields. Am J

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

    Science.gov (United States)

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

    2017-12-01

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

  4. Predisposing Risk Factors and Stress Fractures in Division I Cross Country Runners.

    Science.gov (United States)

    Giffin, Kaci L; Knight, Kathy B; Bass, Martha A; Valliant, Melinda W

    2017-11-11

    The purpose of this study was to explore factors associated with increased stress fractures in collegiate cross country runners. Participants in this study were 42 male and female cross country runners at a Division I university. Each athlete completed a questionnaire regarding smoking status, vitamin/mineral intake, previous stress fracture history, birth control usage, menstrual status, and demographic information. Nutritional assessment via a 3-day food record and measurements of whole body, lumbar spine, and hip bone mineral densities (BMD) were also conducted on each athlete. Results indicated that 40% of the female and 35% of the male runners reported a history of stress fracture, and that all of these did not meet the recommended daily energy intake or adequate intakes for calcium or Vitamin D required for their amount of training. Two-tailed t-test found statistically higher incidences of lumbar spine BMD in males and females whose daily calcium and Vitamin D intakes were below minimum requirements as well as for women whose caloric intake was below the required level. When data on the lumbar spine was evaluated, 31% of participants (31.8% of the male and 30% of the female runners) were identified as having osteopenia and 4.8% with osteoporosis. Results warrant a need for future longitudinal studies.

  5. The incidence of hip fractures in Norway -accuracy of the national Norwegian patient registry

    DEFF Research Database (Denmark)

    Høiberg, Mikkel; Gram, Jeppe; Hermann, Pernille

    2014-01-01

    % C.I. 8,934-9,249), excluding only 6.5% of all hip fractures defined by wider definitions. Conclusions: Based on current coding practice in Norway, a reliable national estimate of hip fracture incidences is found by a combination of relevant ICD-10 and NOMESCO codes in the NPR. This method may......Background: Hip fractures incur the greatest medical costs of any fracture. Valid epidemiological data are important to monitor for time-dependent changes. In Norway, hip fractures are registered in the Norwegian Patient Registry (NPR), but no published national validation exists. The aim...... of the present study was a national validation of NPR as a register for hip fractures using diagnostic codes (ICD-10 S 72.0-2) and/or procedure codes (NOMESCO version 1.14 NFBxy (x = 0-9, y = 0-2) or NFJxy (x = 0-9, y = 0-2). Method: A nationwide, population-based cohort comprising a random sub-sample of 1...

  6. Understanding the etiology of the posteromedial tibial stress fracture.

    Science.gov (United States)

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

    2015-09-01

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

  7. Sacral Stress Fracture following the Bone Union of Lumbar Spondylolysis

    Directory of Open Access Journals (Sweden)

    Tatsuro Sasaji

    2016-01-01

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

  8. Micromechanical studies of cyclic creep fracture under stress controlled loading

    DEFF Research Database (Denmark)

    van der Giessen, Erik; Tvergaard, Viggo

    1996-01-01

    is based on numerical unit cell analyses for a planar polycrystal model with the grains and grain boundaries modeled individually, in order to investigate the interactions between the mechanisms involved and to account for the build-up of residual stress fields during cycling. The behaviour of a limiting......This paper deals with a study of intergranular failure by creep cavitation under stress-controlled cyclic loading conditions. Loading is assumed to be slow enough that diffusion and creep mechanisms (including grain boundary sliding) dominate, leading to intergranular creep fracture. This study...

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

    Science.gov (United States)

    Lacazette, A.; Vermilye, J. M.

    2014-12-01

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

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

    African Journals Online (AJOL)

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

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

    International Nuclear Information System (INIS)

    Smith, E.

    1980-01-01

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

  12. Temporal Bone Fractures and its Classification: Retrospective Study of Incidence, Causes, Clinical Features, Complications and Outcome

    Directory of Open Access Journals (Sweden)

    Umamaheshwari Basavaraju

    2017-10-01

    Full Text Available Introduction: Temporal bone fracture is usually associated with high energy head injury and can cause potentially severe complications. Immediate detection of temporal bone fracture and its complications helps in providing early and effective treatment, which if left untreated can have drastic consequences. Aim: The main objective of the study is to document the frequency and most prevalent type of temporal bone fracture, co-existing complications and to establish association between them. Materials and Methods: One year (2015-2016 retrospective study of head injured patients presented to the Emergency Department, Mysore Medical College And Research Institute was conducted. Age and gender distribution, cause of injury, radiological findings, otorhinolaryngological clinical presentations and treatment given were analyzed. The results were tabulated and were evaluated by Microsoft Excel 2013. Results: Out of 1450 patients evaluated for head injury 154 patients were positive for temporal bone fracture. Incidence of the study was 10.6%. Majority of the patients were male (66.2% and were between 30 to 40 years (50.1%. The major cause of injury was motor vehicle accidents (84.48%. Right side was involved (58.4% more than the left side (41.5%. Most common clinical presentation was otorrhea 68.8%, followed by otalgia (35.04% and otorhinorrhea (24.67%. Longitudinal type fracture was most frequent 56.25%. Otic capsule involvement was present in 35.93%. Most of the fractures were managed conservatively whereas surgery was required in 12 patients (7.7%. Conclusion: Temporal bone fractures were frequently associated with severe traumatic brain injury leading to serious long term morbidity and sequelae. CT-scan is of utmost importance in detection of fractures and its complications.

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

    Science.gov (United States)

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

    2011-03-01

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

  14. Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint dislocations: Incidence and risk factors.

    Science.gov (United States)

    Ottomeyer, Christina; Taylor, Benjamin C; Isaacson, Mark; Martinez, Lara; Ebaugh, Pierce; French, Bruce G

    2017-02-01

    Simultaneous ipsilateral clavicle and acromioclavicular (AC) joint injury have been infrequently reported in the literature at this time. The purpose of this study was to assess incidence as well as assess risk factors for this dual injury pattern. We performed a retrospective review of a prospectively collected database (Level III evidence), evaluating 383 adult patients without previous shoulder girdle injury or trauma with a minimum 1-year follow-up who sustained a displaced diaphyseal clavicle fracture. All patients in the study underwent either nonoperative management or surgical reduction and stabilization of a diaphyseal clavicle fracture with a plate and screw construct. Study subjects were followed with serial radiographs. Clavicle and shoulder radiographs, as well as chest radiographs and contralateral films in questionable cases, were used to assess for acromioclavicular joint injury in both operative and nonoperative groups. Additional data was collected on concurrent injuries, patient demographics, fracture characteristics, fixation techniques, surgical/post-operative data, and operative or nonoperative treatment. We found that 13/183 (7.1%) of patients undergoing fixation of a diaphyseal clavicle fracture had an ipsilateral AC joint injury, while 13/200 (6.5%) of patients undergoing conservative management had an ipsilateral AC joint injury. Critical analysis of the data revealed that presence of ipsilateral scapular body fractures, and a likely incidental association with superior plating fixation, were associated with an increased rate of this injury pattern. Ipsilateral clavicle fracture and AC joint injury is much more common than traditionally believed, with an incidence of 6.8% overall. It is unknown how the presence of an associated AC injury influences outcome, as AC injury was not universally symptomatic. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Incidence of thoracic vertebral fractures among adult health study participants, Hiroshima and Nagasaki, 1958-86

    International Nuclear Information System (INIS)

    Fujiwara, Saeko; Mizuno, Shoichi; Ochi, Yoshimichi; Sasaki, Hideo; Kodama, Kazunori; Russell, W.J.; Hosoda, Yutaka.

    1990-01-01

    The incidence of thoracic vertebral fractures (TVF) in a fixed Hiroshima and Nagasaki population of 16,027 was determined by sex, age, and atomic bomb ionizing radiation exposure. Diagnosis was based on lateral chest radiographs made from 1 July 1958 to 28 February 1986. Born between 1880 and 1940, the subjects were categorized by sex into 10-year birth cohorts. When examined by birth cohort and age at onset, the age dependency of TVF incidence showed a good fit to a log-linear regression model. In females, TVF incidence tended to be lower in the younger birth cohorts and tended to increase with age in all birth cohorts. With each 10-year increase in age, the incidence among females increased by a factor of 1.7. In males, the incidence was significantly lower in the younger birth cohorts, but did not increase with age. The incidence decreased by a factor of 0.5 in males and 0.6 in females as the birth cohort age became younger. TVF incidence was greater in males until the age of 50, was equal by sex in the sixth decade, and was greater among females, who were 60 years of age or older. TVF incidence did not differ by city, and no correlation with A-bomb radiation exposure was demonstrated. (author)

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

    National Research Council Canada - National Science Library

    Jones, D

    1995-01-01

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

  17. Impact of a community-based osteoporosis and fall prevention program on fracture incidence

    OpenAIRE

    Grahn Kronhed, Ann-Charlotte; Blomberg, Carina; Karlsson, Nadine; Löfman, Owe; Timpka, Toomas; Möller, Margareta

    2005-01-01

    Artikkelen rapporterer en studie hvor hensikten var å utforske om kommunebasert intervensjonsprogram for osteoporose og fallforebygging er assosiert med reduksjon av forekomst på overarms- og hoftebrudd eller ikke blant middelaldrende og eldre. Associations between a 10-year community-based osteoporosis and fall prevention program and fracture incidence amongst middle-aged and elderly residents in an intervention community are studied, and comparisons are made with a control community. A h...

  18. Navicular stress fractures treated with minimally invasive fixation

    Directory of Open Access Journals (Sweden)

    Korula Mani Jacob

    2013-01-01

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

  19. The influence of orthopedic corsets on the incidence of pathological fractures in patients with spinal bone metastases after radiotherapy

    International Nuclear Information System (INIS)

    Rief, Harald; Förster, Robert; Rieken, Stefan; Bruckner, Thomas; Schlampp, Ingmar; Bostel, Tilman; Debus, Jürgen

    2015-01-01

    Clinical care of unstable spinal bone metastases in many centers often includes patient immobilization by means of an orthopedic corset in order to prevent pathological fractures. The aim of this retrospective analysis was to evaluate the incidence of pathological fractures after radiotherapy (RT) in patients with and without orthopedic corsets and to assess prognostic factors for pathological fractures in patients with spinal bone metastases. The incidence of pathological fractures in 915 patients with 2.195 osteolytic metastases in the thoracic and lumbar spine was evaluated retrospectively on the basis of computed tomography (CT) scans between January 2000 and January 2012 depending on prescription and wearing of patient—customized orthopedic corsets. In the corset group, 6.8 and 8.0 % in no-corset group showed pathological fractures prior to RT, no significant difference between groups was detected (p = 0.473). After 6 months, patients in the corset group showed pathological fractures in 8.6 % and in no-corset group in 9.3 % (p = 0.709). The univariate and bivariate analyses demonstrated no significant prognostic factor for incidence of pathological fractures in both groups. In this analysis, we could show for the first time in more than 900 patients, that abandoning a general corset supply in patients with spinal metastases does not significantly cause increased rates of pathological fractures. Importantly, the incidence of pathological fracture after RT was small

  20. Residual stress effects in LMFBR fracture assessment procedures

    International Nuclear Information System (INIS)

    Hooton, D.G.

    1984-01-01

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

  1. Hydraulic fracturing rock stress measurement at Haestholmen, Finland

    International Nuclear Information System (INIS)

    Ljunggren, C.; Klasson, H.

    1992-12-01

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

  2. Effect of Birth Cohort on Risk of Hip Fracture: Age-Specific Incidence Rates in the Framingham Study

    Science.gov (United States)

    Samelson, Elizabeth J.; Zhang, Yuqing; Kiel, Douglas P.; Hannan, Marian T.; Felson, David T.

    2002-01-01

    Objectives. This study examined the effect of birth cohort on incidence rates of hip fracture among women and men in the Framingham Study. Methods. Age-specific incidence rates of first hip fracture were presented according to tertile of year of birth for 5209 participants of the Framingham Study, a population-based cohort followed since 1948. Sex-specific incidence rate ratios were calculated by Cox regression to assess the relation between birth cohort and hip fracture incidence. Results. An increasing trend in hip fracture incidence rates was observed with year of birth for women (trend, P = .05) and men (trend, P = .03). Relative to those born from 1887 to 1900 (incidence rate ratio [IRR] = 1.0), age-specific incidence rates were greatest in the most recent birth cohort, born from 1911 to 1921 (IRR = 1.4 for women, IRR = 2.0 for men), and intermediate in those born from 1901 to 1910 (IRR = 1.2 for women, IRR = 1.5 for men). Conclusions. Results suggest risk of hip fracture is increasing for successive birth cohorts. Projections that fail to account for the increase in rates associated with birth cohort underestimate the future public health impact of hip fracture in the United States. PMID:11988460

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

    Science.gov (United States)

    Robertson, Greg A J; Wood, Alexander M

    2017-01-01

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

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

    Science.gov (United States)

    Robertson, Greg A J; Wood, Alexander M

    2017-03-18

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

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

    International Nuclear Information System (INIS)

    Oestreich, Alan E.; Bhojwani, Nicholas

    2010-01-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-08-15

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

  8. The diagnosis of stress fractures of runners by an isotope scintigraphy

    International Nuclear Information System (INIS)

    Karvonen, J.; Nieminen, M.

    1988-01-01

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

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

    Science.gov (United States)

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

    2016-04-01

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

  10. Stress, Flow and Particle Transport in Rock Fractures

    Energy Technology Data Exchange (ETDEWEB)

    Koyama, Tomofumi

    2007-09-15

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

  11. Alzheimer's Disease Increases the Incidence of Hospitalization Due to Fall-related Bone Fracture in Elderly Chinese

    Directory of Open Access Journals (Sweden)

    Fang Li

    2016-12-01

    Conclusion: On the basis of our findings, we conclude that AD may increase the incidence of hospitalization due to falls and bone fracture. We also found that AD has no effect on fracture location, but larger studies are needed to confirm this finding. Physicians and family members should emphasize the possibility of falls and bone fracture in patients with AD. Our findings suggest that preventing falls in AD patients may reduce the number of hospitalized AD patients.

  12. Factors associated with recurrent fifth metatarsal stress fracture.

    Science.gov (United States)

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

    2013-12-01

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

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

    Directory of Open Access Journals (Sweden)

    John Orchard

    2010-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Selahattin Özyürek

    2010-12-01

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

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

    Science.gov (United States)

    2017-10-01

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

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

    OpenAIRE

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

    2015-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-01-01

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

  18. Potential Explanatory Factors for Higher Incident Hip Fracture Risk in Older Diabetic Adults

    Directory of Open Access Journals (Sweden)

    Elsa S. Strotmeyer

    2011-01-01

    Full Text Available Type 2 diabetes is associated with higher fracture risk. Diabetes-related conditions may account for this risk. Cardiovascular Health Study participants (N=5641; 42.0% men; 15.5% black; 72.8±5.6 years were followed 10.9 ± 4.6 years. Diabetes was defined as hypoglycemic medication use or fasting glucose (FG ≥126 mg/dL. Peripheral artery disease (PAD was defined as ankle-arm index <0.9. Incident hip fractures were from medical records. Crude hip fracture rates (/1000 person-years were higher for diabetic vs. non-diabetic participants with BMI <25 (13.6, 95% CI: 8.9–20.2 versus 11.4, 95% CI: 10.1–12.9 and BMI ≥25 to <30 (8.3, 95% CI: 5.7–11.9 versus 6.6, 95% CI: 5.6–7.7, but similar for BMI ≥30. Adjusting for BMI, sex, race, and age, diabetes was related to fractures (HR = 1.34; 95% CI: 1.01–1.78. PAD (HR = 1.25 (95% CI: 0.92–1.57 and longer walk time (HR = 1.07 (95% CI: 1.04–1.10 modified the fracture risk in diabetes (HR = 1.17 (95% CI: 0.87–1.57. Diabetes was associated with higher hip fracture risk after adjusting for BMI though this association was modified by diabetes-related conditions.

  19. Size-corrected BMD decreases during peak linear growth: implications for fracture incidence during adolescence.

    Science.gov (United States)

    Faulkner, Robert A; Davison, K Shawn; Bailey, Donald A; Mirwald, Robert L; Baxter-Jones, Adam D G

    2006-12-01

    Peak adolescent fracture incidence at the distal end of the radius coincides with a decline in size-corrected BMD in both boys and girls. Peak gains in bone area preceded peak gains in BMC in a longitudinal sample of boys and girls, supporting the theory that the dissociation between skeletal expansion and skeletal mineralization results in a period of relative bone weakness. The high incidence of fracture in adolescence may be related to a period of relative skeletal fragility resulting from dissociation between bone expansion and bone mineralization during the growing years. The aim of this study was to examine the relationship between changes in size-corrected BMD (BMDsc) and peak distal radius fracture incidence in boys and girls. Subjects were 41 boys and 46 girls measured annually (DXA; Hologic 2000) over the adolescent growth period and again in young adulthood. Ages of peak height velocity (PHV), peak BMC velocity (PBMCV), and peak bone area (BA) velocity (PBAV) were determined for each child. To control for maturational differences, subjects were aligned on PHV. BMDsc was calculated by first regressing the natural logarithms of BMC and BA. The power coefficient (pc) values from this analysis were used as follows: BMDsc = BMC/BA(pc). BMDsc decreased significantly before the age of PHV and then increased until 4 years after PHV. The peak rates in radial fractures (reported from previous work) in both boys and girls coincided with the age of negative velocity in BMDsc; the age of peak BA velocity (PBAV) preceded the age of peak BMC velocity (PBMCV) by 0.5 years in both boys and girls. There is a clear dissociation between PBMCV and PBAV in boys and girls. BMDsc declines before age of PHV before rebounding after PHV. The timing of these events coincides directly with reported fracture rates of the distal end of the radius. Thus, the results support the theory that there is a period of relative skeletal weakness during the adolescent growth period caused, in

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

    International Nuclear Information System (INIS)

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

    1996-01-01

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

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

    Science.gov (United States)

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

    2006-05-01

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

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

    Science.gov (United States)

    Constantinou, Demitri; Kastanos, Konstantinos

    2008-01-01

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

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

    Science.gov (United States)

    Okudan, Berna; Coşkun, Nazım; Arıcan, Pelin

    2018-02-01

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

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

    Directory of Open Access Journals (Sweden)

    Berna Okudan

    2018-02-01

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

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

    Science.gov (United States)

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

    2017-04-01

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

  6. Imaging of upper extremity stress fractures in the athlete.

    Science.gov (United States)

    Anderson, Mark W

    2006-07-01

    Although it is much less common than injuries in the lower extremities, an upper extremity stress injury can have a significant impact on an athlete. If an accurate and timely diagnosis is to be made, the clinician must have a high index of suspicion of a stress fracture in any athlete who is involved in a throwing, weightlifting, or upper extremity weight-bearing sport and presents with chronic pain in the upper extremity. Imaging should play an integral role in the work-up of these patients; if initial radiographs are unrevealing, further cross-sectional imaging should be strongly considered. Although a three-phase bone scan is highly sensitive in this regard, MRI has become the study of choice at most centers.

  7. Stress fractures of the hind limb in 2 Thoroughbreds

    International Nuclear Information System (INIS)

    Nelson, A.

    1994-01-01

    Stress factures are a common arthopaedic injury in human and equine athletes (McBryde 1985; Mackey et al. 1987). Although often presenting as acute lameness in the horse they are the accumulation of a long period of bone remodelling and eventual failure (Jones and Harris 1989). Gamma scintigraphy has been useful in the diagnosis of stress fractures in humans (Prather et al. 1977) and horses (Devous and Twardock 1984) and is more sensitive than radiography due to its ability to detect functional changes in bone metabolism (Matin 1988). Gamma scintigraphy may be performed in the horse using a hand held probe (Pilsworth 1989) or a gamma camera (Ueltshi 1977). The following cases were both investigated using a gamma camera and dedicated computer system (Elscint UK, Colonial Business Park, Watford, UK)

  8. [Second victim : Critical incident stress management in clinical medicine].

    Science.gov (United States)

    Schiechtl, B; Hunger, M S; Schwappach, D L; Schmidt, C E; Padosch, S A

    2013-09-01

    Critical incidents in clinical medicine can have far-reaching consequences on patient health. In cases of severe medical errors they can seriously harm the patient or even lead to death. The involvement in such an event can result in a stress reaction, a so-called acute posttraumatic stress disorder in the healthcare provider, the so-called second victim of an adverse event. Psychological distress may not only have a long lasting impact on quality of life of the physician or caregiver involved but it may also affect the ability to provide safe patient care in the aftermath of adverse events. A literature review was performed to obtain information on care giver responses to medical errors and to determine possible supportive strategies to mitigate negative consequences of an adverse event on the second victim. An internet search and a search in Medline/Pubmed for scientific studies were conducted using the key words "second victim, "medical error", "critical incident stress management" (CISM) and "critical incident stress reporting system" (CIRS). Sources from academic medical societies and public institutions which offer crisis management programs where analyzed. The data were sorted by main categories and relevance for hospitals. Analysis was carried out using descriptive measures. In disaster medicine and aviation navigation services the implementation of a CISM program is an efficient intervention to help staff to recover after a traumatic event and to return to normal functioning and behavior. Several other concepts for a clinical crisis management plan were identified. The integration of CISM and CISM-related programs in a clinical setting may provide efficient support in an acute crisis and may help the caregiver to deal effectively with future error events and employee safety.

  9. Visual impairment and the incidence of falls and fractures among older people: longitudinal findings from the Blue Mountains Eye Study.

    Science.gov (United States)

    Hong, Thomas; Mitchell, Paul; Burlutsky, George; Samarawickrama, Chameen; Wang, Jie Jin

    2014-11-04

    We assessed the impact of visual impairment on the incidence of falls and fractures in older persons. Of 3654 baseline participants, 2334, 1952, and 1149 were re-examined after 5, 10, and 15 years. Presenting visual acuity (VA) was measured at each examination. Bilateral and unilateral visual impairment was defined as VA worse than 20/40 in the better and worse eye, respectively. Incident visual impairment was defined in eyes with VA 20/40 or better at baseline, which subsequently developed visual impairment. Incidence of falls was assessed over the 12 months before each visit, whereas incidence of fractures was assessed over the 5 years between two visits. Discrete logistic-regression models with time-dependent variables were used to assess associations between visual impairment and subsequent falls and fractures after adjusting for potential confounding variables. The proportions of participants reporting ≥2 falls ranged between 10% and 14%, and proportions reporting fractures ranged between 12% and 21%, across the three follow-up visits. Participants with incident visual impairment were more likely to report ≥2 falls in 5 years, OR (odds ratio) 1.46, 95% confidence interval (CI) 1.04 to 2.04 (bilateral), and OR 1.22, 95% CI 0.98 to 1.51 (unilateral). Compared to participants with normal vision, those with incident unilateral visual impairment had a higher incidence of fractures over 5 years (OR, 1.27; 95% CI, 0.98-1.51). No increased incidence of falls or fractures was evident after 5+ years among participants with visual impairment. In this older cohort, recent development of visual impairment was associated with increased likelihood of subsequent falls and fractures in the next 5 years, independent of other confounding variables. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

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

    Science.gov (United States)

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

    2011-03-01

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

  11. Fracture Incidence and Characteristics in Young Adults Aged 18 to 49 Years: A Population-Based Study.

    Science.gov (United States)

    Farr, Joshua N; Melton, L Joseph; Achenbach, Sara J; Atkinson, Elizabeth J; Khosla, Sundeep; Amin, Shreyasee

    2017-12-01

    Although fractures in both the pediatric and, especially, the elderly populations have been extensively investigated, comparatively little attention has been given to the age group in between. Thus, we used the comprehensive (inpatient and outpatient) data resources of the Rochester Epidemiology Project to determine incidence rates for all fractures among young adult (age range, 18 to 49 years) residents of Olmsted County, Minnesota, in 2009 to 2011, and compared the distribution of fracture sites and causes in this young adult cohort with those for older residents aged 50 years or older. During the 3-year study period, 2482 Olmsted County residents aged 18 to 49 years experienced 1 or more fractures. There were 1730 fractures among 1447 men compared with 1164 among 1035 women, and the age-adjusted incidence of all fractures was 66% greater among the men (1882 [95% confidence interval 1793-1971] versus 1135 [95% CI 1069-1201] per 100,000 person-years; p age ≥50 years who sustained a fracture in 2009 to 2011. Younger residents (aged 18 to 49 years), when compared with older residents (aged ≥50 years), had a greater proportion of fractures of the hands and feet (40% versus 18%) with relatively few fractures observed at traditional osteoporotic fracture sites (14% versus 43%). Vertebral fractures were still more likely to be the result of moderate trauma than at other sites, especially in younger women. In conclusion, whereas pediatric and elderly populations often fracture from no more than moderate trauma, young adults, and more commonly men, suffer fractures primarily at non-osteoporotic sites due to more significant trauma. © 2017 American Society for Bone and Mineral Research. © 2017 American Society for Bone and Mineral Research.

  12. Incremental predictive value of sarcopenia for incident fracture in an elderly Chinese cohort: results from the Osteoporotic Fractures in Men (MrOs) Study.

    Science.gov (United States)

    Yu, Ruby; Leung, Jason; Woo, Jean

    2014-08-01

    We examined whether sarcopenia is predictive of incident fractures among older men, whether the inclusion of sarcopenia in models adds any incremental value to bone mineral density (BMD), and whether sarcopenia is associated with a higher risk of fractures in elderly with osteoporosis. A cohort of 2000 community-dwelling men aged ≥65 years were examined for which detailed information regarding demographics, socioeconomic, medical history, clinical, and lifestyle factors were documented. Body composition and BMD were measured using dual energy X-ray absorptiometry. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) algorithm. Incident fractures were documented during the follow-up period from 2001 to 2013, and related to sarcopenia and its component measures using Cox proportional hazard regressions. The contribution of sarcopenia for predicting fracture risk was evaluated by receiver operating characteristic analysis, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). During an average of 11.3 years of follow-up, 226 (11.3%) men sustained at least 1 incident fracture, making the incidence of fractures 1200.6/100,000 person-years. After multivariate adjustments, sarcopenia was associated with increased fracture risk (hazard ratio [HR], 1.87, 95% confidence interval [CI], 1.26-2.79) independent of BMD and other clinical risk factors. The addition of sarcopenia did not significantly increase area under curve or IDI but significantly improved the predictive ability on fracture risk over BMD and other clinical risk factors by 5.12% (P sarcopenia (sarco-osteoporosis) resulted in a significantly increased risk of fractures (HR, 3.49, 95% CI, 1.76-6.90) compared with those with normal BMD and without sarcopenia. This study confirms that sarcopenia is a predictor of fracture risk in this elderly men cohort, establishes that sarcopenia provides incremental predictive value for fractures over the

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

    International Nuclear Information System (INIS)

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

    2008-01-01

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

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

    International Nuclear Information System (INIS)

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

    1995-01-01

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

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

    Science.gov (United States)

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

    2017-12-01

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

  16. Stress Wave Source Characterization: Impact, Fracture, and Sliding Friction

    Science.gov (United States)

    McLaskey, Gregory Christofer

    Rapidly varying forces, such as those associated with impact, rapid crack propagation, and fault rupture, are sources of stress waves which propagate through a solid body. This dissertation investigates how properties of a stress wave source can be identified or constrained using measurements recorded at an array of sensor sites located far from the source. This methodology is often called the method of acoustic emission and is useful for structural health monitoring and the noninvasive study of material behavior such as friction and fracture. In this dissertation, laboratory measurements of 1--300 mm wavelength stress waves are obtained by means of piezoelectric sensors which detect high frequency (10 kHz--3MHz) motions of a specimen's surface, picometers to nanometers in amplitude. Then, stress wave source characterization techniques are used to study ball impact, drying shrinkage cracking in concrete, and the micromechanics of stick-slip friction of Poly(methyl methacrylate) (PMMA) and rock/rock interfaces. In order to quantitatively relate recorded signals obtained with an array of sensors to a particular stress wave source, wave propagation effects and sensor distortions must be accounted for. This is achieved by modeling the physics of wave propagation and transduction as linear transfer functions. Wave propagation effects are precisely modeled by an elastodynamic Green's function, sensor distortion is characterized by an instrument response function, and the stress wave source is represented with a force moment tensor. These transfer function models are verified though calibration experiments which employ two different mechanical calibration sources: ball impact and glass capillary fracture. The suitability of the ball impact source model, based on Hertzian contact theory, is experimentally validated for small (˜1 mm) balls impacting massive plates composed of four different materials: aluminum, steel, glass, and PMMA. Using this transfer function approach

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

    Directory of Open Access Journals (Sweden)

    Ellen A. Almirol

    2016-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Hiroyuki Fujioka

    2009-06-01

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

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

    Science.gov (United States)

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

    2010-02-01

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

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

    International Nuclear Information System (INIS)

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

    1985-01-01

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

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

    DEFF Research Database (Denmark)

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

    2005-01-01

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

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

    Science.gov (United States)

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

    2007-08-01

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

  3. Incidence rate of mild traumatic brain injury among patients who have suffered from an isolated limb fracture: Upper limb fracture patients are more at risk.

    Science.gov (United States)

    Jodoin, Marianne; Rouleau, Dominique M; Charlebois-Plante, Camille; Benoit, Benoit; Leduc, Stéphane; Laflamme, G-Yves; Gosselin, Nadia; Larson-Dupuis, Camille; De Beaumont, Louis

    2016-08-01

    This study compares the incidence rate of mild traumatic brain injury (mild TBI) detected at follow-up visits (retrospective diagnosis) in patients suffering from an isolated limb trauma, with the incidence rate held by the hospital records (prospective diagnosis) of the sampled cohort. This study also seeks to determine which types of fractures present with the highest incidence of mild TBI. Retrospective assessment of mild TBI among orthopaedic monotrauma patients, randomly selected for participation in an Orthopaedic clinic of a Level I Trauma Hospital. Patients in the remission phase of a limb fracture were recruited between August 2014 and May 2015. No intervention was done (observational study). Standardized semi-structured interviews were conducted with all patients to retrospectively assess for mild TBI at the time of the fracture. Emergency room related medical records of all patients were carefully analyzed to determine whether a prospective mild TBI diagnosis was made following the accident. A total of 251 patients were recruited (54% females, Mean age=49). Study interview revealed a 23.5% incidence rate of mild TBI compared to an incidence rate of 8.8% for prospective diagnosis (χ(2)=78.47; plimb monotrauma (29.6%; n=42/142) are significantly more at risk of sustaining a mild TBI compared to lower limb fractures (15.6%; n=17/109) (χ(2)=6.70; p=0.010). More specifically, patients with a proximal upper limb injury were significantly more at risk of sustaining concomitant mild TBI (40.6%; 26/64) compared to distal upper limb fractures (20.25%; 16/79) (χ(2)=7.07; p=0.008). Results suggest an important concomitance of mild TBI among orthopaedic trauma patients, the majority of which go undetected during acute care. Patients treated for an upper limb fracture are particularly at risk of sustaining concomitant mild TBI. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Trabecular stress fractures during fluoride therapy for osteoporosis

    International Nuclear Information System (INIS)

    Schnitzler, C.M.; Solomon, L.

    1985-01-01

    Joint pain and swelling in patients on fluoride therapy are generally attributed to rheumatic phenomena; however, their occurrence exclusively in the lower limbs suggests a mechanical cause. Eight patients receiving daily doses of sodium fluoride 1.09 mg/kg, elemental calcium 1 gm, and vitamin D 1000-2800 units for osteoporosis spontaneously developed 17 episodes of periarticular pain and swelling in the lower limbs. Radiographs taken within two weeks of the onset of pain were negative, but when repeated 4-6 weeks later showed features of healing stress fractures in the periarticular cancellous bone at the following sites: distal femur (2) proximal tibia (3), distal tibia (6), calcaneum (6). Bone scintigraphy was positive on five occasions, two before radiographic signs had appeared. (orig.)

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

    Directory of Open Access Journals (Sweden)

    Kahanov L

    2015-03-01

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

  6. Incidence and etiology of unplanned cast changes for fractures in the pediatric population.

    Science.gov (United States)

    DiPaola, Matthew J; Abzug, Joshua M; Pizzutillo, Peter D; Herman, Martin J

    2014-09-01

    The majority of pediatric fractures are treated in casts due to the child's ability to heal rapidly and remodel. Unplanned cast changes are a time and economic burden with potentially adverse effects on fracture management. The purpose of this study is to document the incidence, etiology, and complications related to unplanned cast changes. A prospective study was conducted over a 6-month period to determine the incidence of unplanned cast changes. All casts applied were nonwaterproof. Data collected include the reason for cast placement, type of cast placed, duration of wear before the unplanned change, reason for the unplanned change, experience level of the original cast applicator, and cast-related complications. A total of 1135 casts were placed with 58% placed by a resident, 38% by a cast technician, 2% by a physician's assistant, and 2% by an attending physician. Sixty casts (5.3%) required an unplanned change including 19 short-arm casts, 18 short-leg casts, 17 long-arm casts, 4 thumb spica casts, and 2 long-leg casts. The average duration from cast application until the unplanned change was 13 days. Twenty-eight (47%) were changed for wetness, 20 (33%) for wear/breakage, 2 (3%) for skin irritation, and 10 (17%) for other reasons including objects in the cast and patient self-removal. Two patients had superficial skin infections requiring oral antibiotics. No fracture reductions were lost secondary to an unplanned cast change. The need for an unplanned cast change did not correlate with the level of experience of the applicator. Most unplanned cast changes were the result of patient nonadherence to instructions and not related to cast application technique. Improved patient and family education regarding cast care may reduce the frequency of unplanned cast changes, thus reducing an economic and time burden on the health care system. Level II--prognostic study.

  7. Evolution of stress and seismicity in fractured geothermal reservoirs

    Energy Technology Data Exchange (ETDEWEB)

    Schoenball, Martin

    2014-05-05

    Heat Mining, Soultz, forms the basis of the studies. The PhD project was conducted partly within the FP7 GEISER (Geothermal Engineering Integrating Mitigation of Induced Seismicity in Reservoirs) project, funded by the European Commission and it benefited largely from fruitful collaborations with Universite de Strasbourg, Geowatt AG, Zuerich, GFZ German Research Centre for Geosciences, Potsdam and CSIRO Earth Science and Resources Engineering, Perth. In the first study, I analyze whether interaction of seismicity by static stress transfer plays a significant role on the spatio-temporal evolution of seismicity. I follow an analytical approach to compute the displacement field of a rectangular earthquake source. Through stacking of several sources, realistic slip distributions are obtained. The analysis reveals seemingly random distributed patches of stress increase and stress decrease of less than ± 1 MPa, except for very localized areas. Since the fracture planes have varying orientations, they form a volumetric fracture network. About 60% of hypocenters are found in areas with increased Coulomb stress where their potential for failure was increased by static stress transfer. A different behavior is observed for slippage of neighboring asperities on larger fault zones. Here, failure of asperities leads to a direct stress increase in adjacent asperities, which are then more likely to fail. This is exemplified on a cluster of events occurring on the largest fault zone in Soultz, after shut-in of the well GPK2. Subsequently, the peculiar behavior of seismicity and the hydraulic regime following shut-in of the well GPK2 is highlighted and investigated by further analysis of focal mechanism solutions. An increase of the thrust faulting component following shut-in is observed. The changes of the stress field are derived from spatio-temporally resolved inversions of focal mechanism solutions. A very strong reduction of the maximum horizontal stress and an increase of the

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-11-15

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

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

    Science.gov (United States)

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

    2017-12-01

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

  10. Fractures and dislocations of the hand in polytrauma patients: Incidence, injury pattern and functional outcome.

    Science.gov (United States)

    Ferree, Steven; van der Vliet, Quirine M J; van Heijl, Mark; Houwert, Roderick M; Leenen, Luke P H; Hietbrink, Falco

    2017-04-01

    Injuries of the hand can cause significant functional impairment, diminished quality of life and delayed return to work. However, the incidence and functional outcome of hand injuries in polytrauma patients is currently unknown. The aim of this study was to determine the incidence, distribution and functional outcome of fractures and dislocation of the hand in polytrauma patients. A single centre retrospective cohort study was performed at a level 1 trauma centre. Polytrauma was defined as patients with an Injury Severity Score of 16 or higher. Fractures and dislocations to the hand were determined. All eligible polytrauma patients with hand injuries were included and a Quick Disability of Arm, Shoulder and Hand questionnaire (QDASH) and Patient-Rated Wrist/Hand Evaluation (PRWHE) were administered. Patients were contacted 1-6 years after trauma. In a cohort of 2046 polytrauma patients 72 patients (3.5%) suffered a hand injury. The functional outcome scores of 52 patients (72%) were obtained. The Metacarpal (48%) and carpal (33%) bones were the most frequently affected. The median QDASH score for all patients with hand injury was 17 (IQR 0-31) and the PRWHE 14 (IQR 0-41). Patients with a concomitant upper extremity injury (p=0.002 for PRWHE, p0.006 for QDASH) and those with higher ISS scores (p=0.034 for PRWHE, QDASH not significant) had worse functional outcome scores. As an example, of the 5 patients with the worst outcome scores 3 suffered an isolated phalangeal injury, all had concomitant upper extremity injury or neurological injuries (3 plexus injuries, 1 severe brain injury). The incidence of hand injuries in polytrauma patients is 3.5%, which is relatively low compared to a general trauma population. Metacarpal and carpal bones were most frequently affected. The functional extremity specific outcome scores are highly influenced by concomitant injuries (upper extremity injuries, neurological injuries and higher ISS). Copyright © 2017 Elsevier Ltd. All

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

    International Nuclear Information System (INIS)

    Archambeau, C.B.

    1994-01-01

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

  12. Incidence of trampoline related pediatric fractures in a large district general hospital in the United Kingdom: lessons to be learnt.

    Science.gov (United States)

    Bhangal, K K; Neen, D; Dodds, R

    2006-04-01

    To test the observation that the incidence of trampoline related pediatric fractures is increasing-both nationally and in a large district general hospital. A retrospective analysis was undertaken of patient records establishing mechanism of injury of pediatric fractures over three consecutive summers from 2000-03. Theatre records of fractures treated operatively were used as the initial data source. A statistically significant increase in trampoline related injuries was discovered. This reflects the rising incidence of injuries from national data and furthermore corresponds to the growing popularity of domestic use trampolines in the UK. The incidence of injuries is increasing. There are lessons to be learnt from existing work from countries where trampoline prevalence has been greater for longer. The authors recommend various safety measures that may reduce children's injuries.

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

    International Nuclear Information System (INIS)

    Haggag, F.M.

    1985-01-01

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

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

    International Nuclear Information System (INIS)

    Serata, S.; Oka, S.; Kikuchi, S.

    1996-01-01

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

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

    International Nuclear Information System (INIS)

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

    2008-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-05-15

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

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

    OpenAIRE

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

    2017-01-01

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

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

    International Nuclear Information System (INIS)

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

    2015-01-01

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

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

    Science.gov (United States)

    Jenkins, Andrew

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

  20. Thiazide use is associated with reduced risk for incident lower extremity fractures in men with spinal cord injury.

    Science.gov (United States)

    Carbone, Laura D; Chin, Amy S; Lee, Todd A; Burns, Stephen P; Svircev, Jelena N; Hoenig, Helen M; Bailey, Lauren; Weaver, Frances M

    2014-06-01

    To determine the association between thiazide use and lower extremity fractures in patients who are men with a spinal cord injury (SCI). Cohort study from fiscal years 2002 to 2007. Medical centers. Men (N=6969) with an SCI from the Veterans Affairs (VA) Spinal Cord Dysfunction (SCD) Registry, including 1433 users of thiazides and 5536 nonusers of thiazides. Thiazide use versus nonuse. Incident lower extremity fractures. Among the men, 21% in the VA SCD Registry (fiscal years 2002-2007) included in these analyses used thiazide diuretics. There were 832 incident lower extremity fractures over the time period of this study: 110 fractures (7.7%) in 1433 thiazide users and 722 fractures (13%) in 5536 nonusers of thiazides. In unadjusted and adjusted models alike, thiazide use was associated with at least a one-quarter risk reduction in lower extremity fracture at any given point in time (unadjusted: hazard ratio (HR)=.75; 95% confidence interval (CI), .59-.94; adjusted: HR=.74; 95% CI, .58-.95). Thiazide use is common in men with SCI and is associated with a decreased likelihood for lower extremity fractures. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  1. Body mass index and physical activity in relation to the incidence of hip fracture in postmenopausal women.

    Science.gov (United States)

    Armstrong, Miranda E G; Spencer, Elizabeth A; Cairns, Benjamin J; Banks, Emily; Pirie, Kirstin; Green, Jane; Wright, F Lucy; Reeves, Gillian K; Beral, Valerie

    2011-06-01

    Hip fracture risk is known to increase with physical inactivity and decrease with obesity, but there is little information on their combined effects. We report on the separate and combined effects of body mass index (BMI) and physical activity on hospital admissions for hip fracture among postmenopausal women in a large prospective UK study. Baseline information on body size, physical activity, and other relevant factors was collected in 1996-2001, and participants were followed for incident hip fractures by record linkage to National Health Service (NHS) hospital admission data. Cox regression was used to calculate adjusted relative risks of hip fracture. Among 925,345 postmenopausal women followed for an average of 6.2 years, 2582 were admitted to hospital with an incident hip fracture. Hip fracture risk increased with decreasing BMI: Compared with obese women (BMI of 30+ kg/m(2) ), relative risks were 1.71 [95% confidence interval (CI) 1.47-1.97)] for BMI of 25.0 to 29.9 kg/m(2) and 2.55 (95% CI 2.22-2.94) for BMI of 20.0 to 24.9 kg/m(2). The increase in fracture risk per unit decrease in BMI was significantly greater among lean women than among overweight women (p physical inactivity was associated with an increased risk of hip fracture. There was no significant interaction between the relative effects of BMI and physical activity. For women who reported that they took any exercise versus no exercise, the adjusted relative risk of hip fracture was 0.68 (95% CI 0.62-0.75), with similar results for strenuous exercise. In this large cohort of postmenopausal women, BMI and physical activity had independent effects on hip fracture risk. Copyright © 2011 American Society for Bone and Mineral Research.

  2. Incidence and mechanism of neurological deficit after thoracolumbar fractures sustained in motor vehicle collisions.

    Science.gov (United States)

    Mukherjee, Sourabh; Beck, Chad; Yoganandan, Narayan; Rao, Raj D

    2015-10-09

    OBJECT To determine the incidence of and assess the risk factors associated with neurological injury in motor vehicle occupants who sustain fractures of the thoracolumbar spine. METHODS In this study, the authors queried medical, vehicle, and crash data elements from the Crash Injury Research and Engineering Network (CIREN), a prospectively gathered multicenter database compiled from Level I trauma centers. Subjects had fractures involving the T1-L5 vertebral segments, an Abbreviated Injury Scale (AIS) score of ≥ 3, or injury to 2 body regions with an AIS score of ≥ 2 in each region. Demographic parameters obtained for all subjects included age, sex, height, body weight, and body mass index. Clinical parameters obtained included the level of the injured vertebra and the level and type of spinal cord injury. Vehicular crash data included vehicle make, seatbelt type, and usage and appropriate use of the seatbelt. Crash data parameters included the principal direction of force, change in velocity on impact (ΔV), airbag deployment, and vehicle rollover. The authors performed a univariate analysis of the incidence and the odds of sustaining spinal neurological injury associated with major thoracolumbar fractures with respect to the demographic, clinical, and crash parameters. RESULTS Neurological deficit associated with thoracolumbar fracture was most frequent at extremes of age; the highest rates were in the 0- to 10-year (26.7% [4 of 15]) and 70- to 80-year (18.4% [7 of 38]) age groups. Underweight occupants (OR 3.52 [CI 1.055-11.7]) and obese occupants (OR 3.27 [CI 1.28-8.31]) both had higher odds of sustaining spinal cord injury than occupants with a normal body mass index. The highest risk of neurological injury existed in crashes in which airbags deployed and the occupant was not restrained by a seatbelt (OR 2.35 [CI 0.087-1.62]). Reduction in the risk of neurological injuries occurred when 3-point seatbelts were used correctly in conjunction with the

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

    International Nuclear Information System (INIS)

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

    2000-01-01

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

  4. The Young's Modulus, Fracture Stress, and Fracture Strain of Gellan Hydrogels Filled with Whey Protein Microparticles.

    Science.gov (United States)

    Lam, Cherry Wing Yu; Ikeda, Shinya

    2017-05-01

    Texture modifying abilities of whey protein microparticles are expected to be dependent on pH during heat-induced aggregation of whey protein in the microparticulation process. Therefore, whey protein microparticles were prepared at either pH 5.5 or 6.8 and their effects on small and large deformation properties of gellan gels containing whey protein microparticles as fillers were investigated. The majority of whey protein microparticles had diameters around 2 μm. Atomic force microscopy images showed that whey protein microparticles prepared at pH 6.8 partially collapsed and flatted by air-drying, while those prepared at pH 5.5 did not. The Young's modulus of filled gels adjusted to pH 5.5 decreased by the addition of whey protein microparticles, while those of filled gels adjusted to pH 6.8 increased with increasing volume fraction of filler particles. These results suggest that filler particles were weakly bonded to gel matrices at pH 5.5 but strongly at pH 6.8. Whey protein microparticles prepared at pH 5.5 showed more enhanced increases in the Young's modulus than those prepared at pH 6.8 at volume fractions between 0.2 and 0.4, indicating that microparticles prepared at pH 5.5 were mechanically stronger. The fracture stress of filled gels showed trends somewhat similar to those of the Young's modulus, while their fracture strains decreased by the addition of whey protein microparticles in all examined conditions, indicating that the primary effect of these filler particles was to enhance the brittleness of filled gels. © 2017 Institute of Food Technologists®.

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

    Science.gov (United States)

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

    2017-06-18

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

  6. Influence of ambient ozone on the incidence of bone fractures especially among the elderly

    Energy Technology Data Exchange (ETDEWEB)

    Calabrese, E.J.

    1979-02-01

    Elevated levels of breatheable ozone will reduce the amount of uv radiation in the range of 280 to 305 nm reaching the surface of earth. This range of uv converts the provitamin 7-dehydrocholesterol to vitamin D, within the human. Since most typical diets contain low levels of vitamin D, the role of uv-related vitamin D synthesis in the skin is considered to provide very important contributions to the total vitamin D content of the blood. Thus, elevated levels of ambient ozone should result in a decreased level of vitamin D synthesis which may be expressed as an increase in the incidence of histological osteomalacia and ultimately bone fractures, especially among the elderly.

  7. Ten-year incident osteoporosis-related fractures in the population-based Canadian Multicentre Osteoporosis Study - comparing site and age-specific risks in women and men.

    Science.gov (United States)

    Prior, Jerilynn C; Langsetmo, Lisa; Lentle, Brian C; Berger, Claudie; Goltzman, David; Kovacs, Christopher S; Kaiser, Stephanie M; Adachi, Jonathan D; Papaioannou, Alexandra; Anastassiades, Tassos; Towheed, Tanveer; Josse, Robert G; Brown, Jacques P; Leslie, William D; Kreiger, Nancy

    2015-02-01

    Population-based incident fracture data aid fracture prevention and therapy decisions. Our purpose was to describe 10-year site-specific cumulative fracture incidence by sex, age at baseline, and degree of trauma with/without consideration of competing mortality in the Canadian Multicentre Osteoporosis Study adult cohort. Incident fractures and mortality were identified by annual postal questionnaires to the participant or proxy respondent. Date, site and circumstance of fracture were gathered from structured interviews and medical records. Fracture analyses were stratified by sex and age at baseline and used both Kaplan-Meier and competing mortality methods. The baseline (1995-97) cohort included 6314 women and 2789 men (aged 25-84 years; mean±SD 62±12 and 59±14, respectively), with 4322 (68%) women and 1732 (62%) men followed to year-10. At least one incident fracture occurred for 930 women (14%) and 247 men (9%). Competing mortality exceeded fracture risk for men aged 65+years at baseline. Age was a strong predictor of incident fractures especially fragility fractures, with higher age gradients for women vs. men. Major osteoporotic fracture (MOF) (hip, clinical spine, forearm, humerus) accounted for 41-74% of fracture risk by sex/age strata; in women all MOF sites showed age-related increases but in men only hip was clearly age-related. The most common fractures were the forearm for women and the ribs for men. Hip fracture incidence was the highest for the 75-84 year baseline age-group with no significant difference between women 7.0% (95% CI 5.3, 8.9) and men 7.0% (95% CI 4.4, 10.3). There are sex differences in the predominant sites and age-gradients of fracture. In older men, competing mortality exceeds cumulative fracture risk. Copyright © 2014 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2017-12-01

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

  9. The effect of multiaxial stress state on creep behavior and fracture mechanism of P92 steel

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Yuan; Xu, Hong, E-mail: xuhong@ncepu.edu.cn; Ni, Yongzhong; Lan, Xiang; Li, Hongyuan

    2015-06-11

    The creep experiments on plain and double U-typed notched specimens were conducted on P92 steel at 650 °C. The notch strengthening effect was found in the notched specimens. Fracture appearance observed by scanning electron microscopy revealed that dimpled fracture for relatively blunt notched specimen, and dimpled fracture doubled with intergranular brittle fracture for relatively sharp notched specimen, which meant that fracture mechanism of P92 steel altered due to the presence of the notch. Meanwhile, based on Norton–Bailey and Kachanov–Robotnov constitutive models, a modified model was proposed. Finite element simulations were carried out to investigate the effect of multiaxial stress state on the creep behavior, fracture mechanism and damage evolvement of P92 steel. The simulation results agreed well with the fracture behaviors observed experimentally.

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

    Science.gov (United States)

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

    2017-03-15

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

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

    DEFF Research Database (Denmark)

    Bisdom, Kevin; Bertotti, Giovanni; Nick, Hamid

    2016-01-01

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

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

    NARCIS (Netherlands)

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

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    S Sengupta

    2008-04-01

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

  14. Stress analysis of implant-bone fixation at different fracture angle

    Science.gov (United States)

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

    2017-10-01

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

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

    LENUS (Irish Health Repository)

    Murphy, Colin G

    2012-01-31

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

  16. Association of stressful life events with accelerated bone loss in older men: the Osteoporotic Fractures in Men (MrOS) Study

    Science.gov (United States)

    Fink, Howard A.; Kuskowski, Michael A.; Cauley, Jane A.; Taylor, Brent C.; Schousboe, John T.; Cawthon, Peggy M.; Ensrud, Kristine E.

    2015-01-01

    Purpose/Introduction Prior studies suggest that stressful life events may increase adverse health outcomes, including falls and possibly fractures. The current study builds on these findings and examines whether stressful life events are associated with increased bone loss. Methods 4388 men aged ≥65 years in the Osteoporotic Fractures in Men study completed total hip bone mineral density (BMD) measures at baseline and visit 2, approximately 4.6 years later, and self-reported stressful life events data mid-way between baseline and visit 2, and at visit 2. We used linear regression to model the association of stressful life events with concurrent annualized total hip BMD loss, and log binomial regression or Poisson regression to model risk of concurrent accelerated BMD loss (>1 SD more than mean annualized change). Results 75.3% of men reported ≥1 type of stressful life event, including 43.3% with ≥2 types of stressful life events. Mean annualized BMD loss was −0.36% (SD 0.88) and 13.9% of men were categorized with accelerated BMD loss (about 5.7% or more total loss). Rate of annualized BMD loss increased with the number of types of stressful life events after adjustment for age (pstressful life events (RR, 1.10 [95% CI, 1.04–1.16]) per increase of 1 type of stressful life event). Fracture risk was not significantly different between stressful life event-accelerated bone loss subgroups (p=0.08). Conclusions In these older men, stressful life events were associated with a small, dose-related increase in risk of concurrent accelerated hip bone loss. Low frequency of fractures limited assessment of whether rapid bone loss mediates any association of stressful life events with incident fractures. Future studies are needed to confirm these findings and to investigate the mechanism that may underlie this association. PMID:25169421

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

    Science.gov (United States)

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

    2007-02-01

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

  18. Discrete fracture in quasi-brittle materials under compressive and tensile stress states

    CSIR Research Space (South Africa)

    Klerck, PA

    2004-01-01

    Full Text Available A method for modelling discrete fracture in geomaterials under tensile and compressive stress fields has been developed based on a Mohr-Coulomb failure surface in compression and three independent anisotropic rotating crack models in tension...

  19. Bone Geometry as a Predictor of Tissue Fragility and Stress Fracture Risk

    Science.gov (United States)

    2004-10-01

    eferences ........................................................................ 11 A ppendices ...School of Medicine, New York NY Stress fractures occur among persons with normal bones, no acute injury, and are most common among elite runners and

  20. Osteomalacia and coxa vara. An unusual co-existence for femoral neck stress fracture

    Directory of Open Access Journals (Sweden)

    Kerim Sariyilmaz

    2015-01-01

    Conclusion: Joint and bone pain without any trauma should be investigated and bone metabolism disorders should be kept in mind. There might be co-existing factors related with stress fractures, and they must be treated simultaneously.

  1. "Osteoporosis and orthopods" incidences of osteoporosis in distal radius fracture from low energy trauma.

    LENUS (Irish Health Repository)

    Bahari, Syah

    2007-07-01

    Fracture of the distal radius from low energy trauma is a common presentation to orthopaedic trauma services. This fragility type fracture is associated with underlying osteoporosis. Osteoporosis is a \\'silent disease\\' where fragility fracture is a common presentation. Orthopaedic surgeons may be the only physician that these patients encounter. We found a high percentage of female patients who sustained a fragility fracture of the distal radius have an underlying osteoporosis. Further management of osteoporosis is important to prevent future fragility fractures.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-06-15

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

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

    International Nuclear Information System (INIS)

    Baker, Jonathan C.; Demertzis, Jennifer L.

    2016-01-01

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

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

    Science.gov (United States)

    Baker, Jonathan C; Demertzis, Jennifer L

    2016-06-01

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

  5. Incidence of fractures among epilepsy patients: a population-based retrospective cohort study in the General Practice Research Database.

    Science.gov (United States)

    Souverein, Patrick C; Webb, David J; Petri, Hans; Weil, John; Van Staa, Tjeerd P; Egberts, Toine

    2005-02-01

    To compare the incidence of various fractures in a cohort of patients with epilepsy with a reference cohort of patients not having epilepsy. Patients were included in the epilepsy cohort if they had at least one diagnosis of epilepsy in their medical history and had sufficient evidence of "active" epilepsy (use of antiepileptic drugs, diagnoses) after the practice was included in the General Practice Research Database (GPRD). Two reference patients were sampled for each patient with epilepsy from the same practice. Primary outcome was the occurrence of any fracture during follow-up. Poisson regression analysis was used to estimate incidence density ratios (IDRs). The study population comprised 40,485 and 80,970 patients in the epilepsy and reference cohorts, respectively. The median duration of follow-up was approximately 3 years. The overall incidence rate in the epilepsy cohort was 241.9 per 10,000 person-years. This rate was about twice as high as that in reference cohort: age- and sex-adjusted IDR, 1.89 (95% CI, 1.81-1.98). When comparing IDRs among the different groups of fractures, the highest relative-risk estimate was found for hip and femur fractures (adjusted IDR, 2.79; 95% CI, 2.41-3.24). IDRs were consistently elevated across age and sex groups and across fracture subtypes. The overall risk of fractures was nearly twice as high among patients with epilepsy compared with the general population. The relative fracture risk was highest for hip and femur. Further study is necessary to elucidate whether this elevated risk is due to the disease, the use of antiepileptic drugs, or both.

  6. Incidence and Association of CT Findings of Ankle Tendon Injuries in Patients Presenting With Ankle and Hindfoot Fractures.

    Science.gov (United States)

    Golshani, Ashkahn; Zhu, Liang; Cai, Chunyan; Beckmann, Nicholas M

    2017-02-01

    Tendon injuries are a commonly encountered finding in ankle CT examinations performed for fractures. This study was designed to identify the incidence and associations of tendon injuries in ankle CT examinations performed for fractures. A retrospective review was performed of 410 patients who underwent ankle CT during a 6-year period. Tendon injuries were common, seen in 25% of all ankle CT examinations. Tendon subluxation-dislocation accounted for most of the tendon injuries (77 of 196 total injuries). Pilon fractures carried 2.2 times increased risk of tibialis posterior tendon injury (p = 0.0094). Calcaneus fractures carried 11.86 times increased risk of peroneus brevis tendon and 10.71 times increased risk of peroneus longus tendon injury (p < 0.0001). Calcaneus fractures also carried 5.21 times increased risk of flexor hallucis longus tendon injury (p = 0.0024). Talus fracture was associated with injury to all flexor compartment tendons. Talus fractures carried 3.43 times increased risk of tibialis posterior tendon injury (p < 0.0001), 4.51 times increased risk of flexor digitorum longus tendon injury (p = 0.0005), and 6.97 times increased risk of flexor hallucis longus tendon injury (p < 0.0001). Calcaneal fractures are prone to peroneal tendon injury, and talus fractures are prone to flexor tendon injury. In patients with pilon fractures, it is important to look for tibialis posterior tendon injury, specifically for entrapment. Overall, the most common type of injury is tendon malalignment, so it is imperative to know the normal tendon paths and associated bony landmarks to identify tendon injury.

  7. Incidence of posttraumatic stress disorder after traffic accidents in Germany.

    Science.gov (United States)

    Brand, Stephan; Otte, Dietmar; Petri, Maximilian; Decker, Sebastian; Stübig, Timo; Krettek, Christian; Müller, Christian W

    2014-01-01

    Posttraumatic stress disorder (PTSD) is possibly an overlooked diagnosis of victims suffering from traffic accidents sustaining serious to severe injuries. This paper investigates the incidence of PTSD after traffic accidents in Germany. Data from an accident research unit were analyzed in regard to collision details, and preclinical and clinical data. Preclinical data included details on crash circumstances and estimated injury severity as well as data on victims' conditions (e.g. heart rate, blood pressure, consciousness, breath rate). Clinical data included initial assessment in the emergency department, radiographic diagnoses, and basic life parameters comparable to the preclinical data as well as follow-up data on the daily ward. Data were collected in the German-In-Depth Accident Research study, and included gender, type of accident (e.g. type of vehicle, road conditions, rural or urban area), mental disorder, and AIS (Abbreviated Injury Scale) head score. AIS represent a scoring system to measure the injury severity of traffic accident victims. A total 258 out of 32807 data sets were included in this analysis. Data on accident and victims was collected on scene by specialized teams following established algorithms. Besides higher AIS Head scores for male motorcyclists compared to all other subgroups, no significant correlation was found between the mean maximum AIS score and the occurrence of PTSD. Furthermore, there was no correlation between higher AIS head scores, gender, or involvement in road traffic accidents and PTSD. In our study the overall incidence of PTSD after road traffic accidents was very low (0.78% in a total of 32.807 collected data sets) when compared to other published studies. The reason for this very low incidence of PTSD in our patient sample could be seen in an underestimation of the psychophysiological impact of traffic accidents on patients. Patients suffering from direct experiences of traumatic events such as a traffic accident

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

    International Nuclear Information System (INIS)

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

    1984-01-01

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

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

    International Nuclear Information System (INIS)

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

    2007-01-01

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

  10. TIBIAL PERIPROSTHETIC FRACTURE COMBINED WITH TIBIAL STEM STRESS FRACTURE FROM TOTAL KNEE ARTHROPLASTY

    OpenAIRE

    Fonseca, Fernando; Rebelo, Edgar; Completo, Antonio

    2011-01-01

    Total knee arthroplasty complications related to the prosthetic material are very rare, except for polyethylene wear. We report the case of a 58-year-old woman who came to the emergency service of our hospital with a periprosthetic tibial fracture (Mayo Clinic type I). Careful examination showed that this fracture was concomitantly associated with a tibial stem fatigue fracture. The prosthesis and the stem were sent to an independent biomechanics laboratory for evaluation. A finite-element CA...

  11. Incidence of Treatment for Infection of Buried Versus Exposed Kirschner Wires in Phalangeal, Metacarpal, and Distal Radial Fractures.

    Science.gov (United States)

    Ridley, Taylor J; Freking, Will; Erickson, Lauren O; Ward, Christina Marie

    2017-07-01

    To determine whether there is a difference in the incidence of infection between exposed and buried K-wires when used to treat phalangeal, metacarpal, and distal radius fractures. We conducted a retrospective review identifying all patients aged greater than 16 years who underwent fixation of phalangeal, metacarpal, or distal radius fractures with K-wires between 2007 and 2015. We recorded patient demographic data, fracture location, number of K-wires used, whether K-wires were buried or left exposed, and duration of K-wire placement. A total of 695 patients met inclusion criteria. Surgeons buried K-wires in 207 patients and left K-wires exposed in 488. Infections occurred more frequently in exposed K-wire cases than in buried K-wire ones. Subgroup analysis based on fracture location revealed a significantly increased risk of being treated for infection when exposed K-wires were used for metacarpal fractures. Patients with exposed K-wires for fixation of phalangeal, metacarpal, or distal radius fractures were more likely to be treated for a pin-site infection than those with K-wires buried beneath the skin. Metacarpal fractures treated with exposed K-wires were 2 times more likely to be treated for a pin-site infection (17.6% of exposed K wire cases vs 8.7% of buried K wire cases). Therapeutic IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  12. Stress fractures of the rib arising from the manufactory assembly line

    International Nuclear Information System (INIS)

    Arima, Toru; Iwasaki, Masayuki

    2007-01-01

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

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

    Science.gov (United States)

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

    2017-12-01

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

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

    Science.gov (United States)

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

    2016-03-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-08-01

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

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

    International Nuclear Information System (INIS)

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

    2003-01-01

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

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

    Science.gov (United States)

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

    2017-02-01

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

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

    Science.gov (United States)

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

    2009-06-01

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

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

    Science.gov (United States)

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

    2007-09-01

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

  20. kISMET: Stress and fracture characterization in a deep mine

    Science.gov (United States)

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

    2016-12-01

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

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

    Science.gov (United States)

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

    2013-06-01

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

  2. Critical incidents and critical incident stress management (CISM) - an employee assistance programme (EAP) perspective

    OpenAIRE

    Terblanche, Lourie; van Wyk, André

    2014-01-01

    Employees are increasingly becoming victims of critical incidents. From a systems theory point of view, it is necessary to acknowledge the impact of critical incidents not only on the personal life of the employee, but on the workplace itself. Employees respond differently to critical incidents, which makes it even more complicated when this reaches the point of requiring therapeutic intervention. The most common response to critical incidents may be the risk of developing post-traumatic s...

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

    Science.gov (United States)

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

    2008-07-01

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

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

    International Nuclear Information System (INIS)

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

    2010-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-11-15

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

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

    Science.gov (United States)

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

    2013-08-01

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

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

    International Nuclear Information System (INIS)

    Tins, B.; Cassar-Pullicino, V.

    2006-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-11-15

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

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

    International Nuclear Information System (INIS)

    Huyakorn, P.; Golis, M.J.

    1989-01-01

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

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

    Science.gov (United States)

    Low, Sara; Kern, Michael; Atanda, Alfred

    2016-01-01

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

  11. Stress dependence of permeability of intact and fractured shale cores.

    Science.gov (United States)

    van Noort, Reinier; Yarushina, Viktoriya

    2016-04-01

    Whether a shale acts as a caprock, source rock, or reservoir, understanding fluid flow through shale is of major importance for understanding fluid flow in geological systems. Because of the low permeability of shale, flow is thought to be largely confined to fractures and similar features. In fracking operations, fractures are induced specifically to allow for hydrocarbon exploration. We have constructed an experimental setup to measure core permeabilities, using constant flow or a transient pulse. In this setup, we have measured the permeability of intact and fractured shale core samples, using either water or supercritical CO2 as the transporting fluid. Our measurements show decreasing permeability with increasing confining pressure, mainly due to time-dependent creep. Furthermore, our measurements show that for a simple splitting fracture, time-dependent creep will also eliminate any significant effect of this fracture on permeability. This effect of confinement on fracture permeability can have important implications regarding the effects of fracturing on shale permeability, and hence for operations depending on that.

  12. Subchondral stress fracture of femoral head in a healthy adult

    Directory of Open Access Journals (Sweden)

    Anand Ashish

    2010-01-01

    Full Text Available Subchondral fracture of the femoral head is an uncommon entity and usually occurs as an insufficiency fracture associated with poor bone quality or as a fatigue fracture in young military recruits. This condition should be considered in the differential diagnosis of acute hip pain in young patients along with transient osteoporosis and avascular necrosis of the hip. We report a case of acute onset hip pain in an asymptomatic healthy adult in which the diagnosis was made by magnetic resonance imaging and the patient responded well to conservative treatment.

  13. National trends of incidence, treatment, and hospital charges of isolated C-2 fractures in three different age groups.

    Science.gov (United States)

    Kukreja, Sunil; Kalakoti, Piyush; Murray, Richard; Nixon, Menarvia; Missios, Symeon; Guthikonda, Bharat; Nanda, Anil

    2015-04-01

    Incidence of C-2 fracture is increasing in elderly patients. Patient age also influences decision making in the management of these fractures. There are very limited data on the national trends of incidence, treatment interventions, and resource utilization in patients in different age groups with isolated C-2 fractures. The aim of this study is to investigate the incidence, treatment, complications, length of stay, and hospital charges of isolated C-2 fracture in patients in 3 different age groups by using the Nationwide Inpatient Sample (NIS) database. The data were obtained from NIS from 2002 to 2011. Data on patients with closed fractures of C-2 without spinal cord injury were extracted using ICD-9-CM diagnosis code 805.02. Patients with isolated C-2 fractures were identified by excluding patients with other associated injuries. The cohort was divided into 3 age groups: 80 years. Incidence, treatment characteristics, inpatient/postoperative complications, and hospital charges (mean and total annual charges) were compared between the 3 age groups. A total of 10,336 patients with isolated C-2 fractures were identified. The majority of the patients were in the very elderly age group (> 80 years; 42.3%) followed by 29.7% in the 65- to 80-year age group and 28% in age group. From 2002 to 2011, the incidence of hospitalization significantly increased in the 65- to 80-year and > 80-year age groups (p age group (p = 0.287). Overall, 21% of the patients were treated surgically, and 12.2% of the patients underwent nonoperative interventions (halo and spinal traction). The rate of nonoperative interventions significantly decreased over time in all age groups (p age groups had a greater risk of inpatient/postoperative complications, nonroutine discharges, and longer hospitalization. The mean hospital charges were significantly higher in older age groups (p age groups. Simultaneously, there has been a steadily decreasing trend in the preference for nonoperative

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

    Science.gov (United States)

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

    2016-10-18

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

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

    Directory of Open Access Journals (Sweden)

    Naik Monappa A

    2013-04-01

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

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

    International Nuclear Information System (INIS)

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

    1983-01-01

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

  17. Influence of shear and deviatoric stress on the evolution of permeability in fractured rock

    NARCIS (Netherlands)

    Faoro, Igor; Niemeijer, André; Marone, Chris; Elsworth, Derek

    The evolution of permeability in fractured rock as a function of effective normal stress, shear displacement, and damage remains a complex issue. In this contribution, we report on experiments in which rock surfaces were subject to direct shear under controlled pore pressure and true triaxial stress

  18. Consistent stress-strain ductile fracture model as applied to two grades of beryllium

    International Nuclear Information System (INIS)

    Priddy, T.G.; Benzley, S.E.; Ford, L.M.

    1980-01-01

    Published yield and ultimate biaxial stress and strain data for two grades of beryllium are correlated with a more complete method of characterizing macroscopic strain at fracture initiation in ductile materials. Results are compared with those obtained from an exponential, mean stress dependent, model. Simple statistical methods are employed to illustrate the degree of correlation for each method with the experimental data

  19. 99mTc-MDP bone scintigraphy in the diagnosis of stress fracture of the metatarsal bones mimicking oligoarthritis

    Directory of Open Access Journals (Sweden)

    Jauković Ljiljana

    2008-01-01

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

  20. Increased sclerostin associated with stress fracture of the third metacarpal bone in the Thoroughbred racehorse

    Science.gov (United States)

    Singer, E.; Henson, F.

    2018-01-01

    Objectives The exact aetiology and pathogenesis of microdamage-induced long bone fractures remain unknown. These fractures are likely to be the result of inadequate bone remodelling in response to damage. This study aims to identify an association of osteocyte apoptosis, the presence of osteocytic osteolysis, and any alterations in sclerostin expression with a fracture of the third metacarpal (Mc-III) bone of Thoroughbred racehorses. Methods A total of 30 Mc-III bones were obtained; ten bones were fractured during racing, ten were from the contralateral limb, and ten were from control horses. Each Mc-III bone was divided into a fracture site, condyle, condylar groove, and sagittal ridge. Microcracks and diffuse microdamage were quantified. Apoptotic osteocytes were measured using TUNEL staining. Cathepsin K, matrix metalloproteinase-13 (MMP-13), HtrA1, and sclerostin expression were analyzed. Results In the fracture group, microdamage was elevated 38.9% (sd 2.6) compared with controls. There was no difference in the osteocyte number and the percentage of apoptotic cells between contralateral limb and unraced control; however, there were significantly fewer apoptotic cells in fractured samples (p fractured samples, sclerostin expression was significantly higher (p fractured during racing. In this study, this is not associated with osteocyte apoptosis or osteocytic osteolysis. The finding of increased sclerostin in the region of the fracture suggests that this protein may be playing a key role in the regulation of bone microdamage during stress adaptation. Cite this article: N. Hopper, E. Singer, F. Henson. Increased sclerostin associated with stress fracture of the third metacarpal bone in the Thoroughbred racehorse. Bone Joint Res 2018;7:94–102. DOI: 10.1302/2046-3758.71.BJR-2016-0202.R4. PMID:29363519

  1. Use of Noninvasive Bone Structural Measurements to Evaluate Stress Fracture Susceptibility Among Female Recruits in U.S. Marine Corps Basic Training: Individual Profiles of Stress Fracture Susceptibility Among Female Recruits in U.S. Marine Corps Basic Training

    National Research Council Canada - National Science Library

    Shaffer, Rick

    1996-01-01

    The objective of this study was to derive predictive models of stress fracture susceptibility in female military recruits by administering a questionnaire highlighting exercise and health habits prior...

  2. Fracture predictions for cracks exposed to superimposed normal and shear stresses

    International Nuclear Information System (INIS)

    Richard, H.A.

    1985-01-01

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

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

    International Nuclear Information System (INIS)

    Schmidt, P.

    1979-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-07-15

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

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

    International Nuclear Information System (INIS)

    Tresley, Jonathan; Subhawong, Ty K.; Singer, Adam D.; Clifford, Paul D.

    2016-01-01

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

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

    International Nuclear Information System (INIS)

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

    2006-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-11-15

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

  8. Residual stress analysis on materials with steep stress gradient by using X-ray incidence at higher angles

    International Nuclear Information System (INIS)

    Ohya, Shin-ichi; Yoshioka, Yasuo; Maeno, Shigeki

    1996-01-01

    X-ray stress measurements for isotropic polycrystalline are materials are usually carried out by the sin 2 ψ method under the assumption of no stress gradient in X-ray penetration depth. When a steep stress gradient exists in the vicinity of surface layer, however, non-linear sin 2 ψ relation is observed and the sin 2 ψ method cannot be applied on such cases. Although several X-ray stress analyzers have been developed for materials with steep stress gradient in the surface layer, it is desirable to use diffraction data at higher incident angles of ψ 0 as possible as close on 90 degrees in order to determine the both values of surface stress and stress gradient with high accuracy. In the present study, an X-ray stress analyzer based on Ω geometry was fabricated to enable X-ray incidence at higher angle of ψ 0 . The X-ray detector was positioned on -η side against X-ray incident beam. Both of the residual surface stress and stress gradient were determined by use of the COSψ method on shot-peened steel and silicon nitride specimens. This prototype stress analyzer was found effective to perform a biaxial or triaxial stress analysis. (author)

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

    International Nuclear Information System (INIS)

    Rossi, F.; Dragoni, S.

    2005-01-01

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

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

    Science.gov (United States)

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

    2018-05-18

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

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

    Directory of Open Access Journals (Sweden)

    Ali Shafiei

    2018-02-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2005-07-01

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

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

    International Nuclear Information System (INIS)

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

    1987-01-01

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

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

    International Nuclear Information System (INIS)

    Maki, Hideo; Ooyama, Masatosi

    1975-01-01

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

  15. Surgical Management of Proximal Interphalangeal Joint Repetitive Stress Epiphyseal Fracture Nonunion in Elite Sport Climbers.

    Science.gov (United States)

    El-Sheikh, Yasser; Lutter, Chris; Schoeffl, Isabelle; Schoeffl, Volker; Flohe, Sascha

    2017-11-14

    Repetitive stress fracture of the middle phalanx epiphysis is an injury specific to elite adolescent sport climbers. As sport climbing becomes increasingly popular in younger age groups, an increased number of these injuries have been reported in recent years. To date, treatment of these fractures has been nonsurgical, with strict rest and physiotherapy prescribed until fracture union. However, when these patients present in a delayed fashion with an established nonunion, nonsurgical treatment may fail, leading to disabling chronic pain and/or digital deformity in some cases. In this article, we present 2 cases of surgical treatment for finger middle phalanx repetitive stress epiphyseal fracture nonunion, using a percutaneous spot drilling epiphysiodesis technique. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  16. Why is the age-standardized incidence of low-trauma fractures rising in many elderly populations?

    Science.gov (United States)

    Kannus, Pekka; Niemi, Seppo; Parkkari, Jari; Palvanen, Mika; Heinonen, Ari; Sievänen, Harri; Järvinen, Teppo; Khan, Karim; Järvinen, Markku

    2002-08-01

    Low-trauma fractures of elderly people are a major public health burden worldwide, and as the number and mean age of older adults in the population continue to increase, the number of fractures is also likely to increase. Epidemiologically, however, an additional concern is that, for unknown reasons, the age-standardized incidence (average individual risk) of fracture has also risen in many populations during the recent decades. Possible reasons for this rise include a birth cohort effect, deterioration in the average bone strength by time, and increased average risk of (serious) falls. Literature provides evidence that the rise is not due to a birth cohort effect, whereas no study shows whether bone fragility has increased during this relatively short period of time. This osteoporosis hypothesis could, however, be tested if researchers would now repeat the population measurements of bone mass and density that were made in the late 1980s and the 1990s. If such studies proved that women's and men's age-standardized mean values of bone mass and density have declined over time, the osteoporosis hypothesis would receive scientific support. The third explanation is based on the hypothesis that the number and/or severity of falls has risen in elderly populations during the recent decades. Although no study has directly tested this hypothesis, a great deal of indirect epidemiologic evidence supports this contention. For example, the age-standardized incidence of fall-induced severe head injuries, bruises and contusions, and joint distortions and dislocations has increased among elderly people similarly to the low-trauma fractures. The fall hypothesis could also be tested in the coming years because the 1990s saw many research teams reporting age- and sex-specific incidences of falling for elderly populations, and the same could be done now to provide data comparing the current incidence rates of falls with the earlier ones.

  17. Effect of Crack Tip Stress Concentration Factor on Fracture Resistance in Vacuum Environment

    Science.gov (United States)

    2015-01-20

    indicate: (1) in all alloys, the fracture resistance is highest for blunt-notches (smaller Kt), and is lowest for fatigue -sharpened precracked...paths are transgranular and the fracture mode is ductile void coalescence in all cases, irrespective of the stress concentration factor. 20-01-2015...because of corrosion and/or various loading conditions such as fatigue , fretting, abrasion, etc. Also, the geometry of the structure may cause an

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

    Science.gov (United States)

    Caputo, Riccardo; Hancock, Paul L.

    1998-11-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-10-15

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

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

    International Nuclear Information System (INIS)

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

    2007-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Shengtong Di

    2017-01-01

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

  2. Lag screw fixation of dorsal cortical stress fractures of the third metacarpal bone in 116 racehorses.

    Science.gov (United States)

    Jalim, S L; McIlwraith, C W; Goodman, N L; Anderson, G A

    2010-10-01

    The effectiveness and best method to manage dorsal cortical stress fractures is not clear. This study was performed to evaluate the success of lag screw fixation of such fractures in a population of Thoroughbred racehorses. Lag screw fixation of dorsal cortical stress fractures is an effective surgical procedure allowing racehorses to return to their preoperative level of performance. The records of 116 racehorses (103 Thoroughbreds) admitted to Equine Medical Centre, California between 1986 and 2008 were assessed. Information obtained from medical records included subject details, limb(s) affected, fracture configuration, length of screw used in repair and presence of concurrent surgical procedures performed. Racing performance was evaluated relative to these factors using Fisher's exact test and nonparametric methods with a level of significance of Phorses, 83% raced preoperatively and 83% raced post operatively, with 63% having ≥5 starts. There was no statistically significant association between age, gender, limb affected, fracture configuration or presence of concurrent surgery and likelihood of racing post operatively or of having 5 or more starts. The mean earnings per start and the performance index for the 3 races following surgery were lower compared to the 3 races prior to surgery; however, 29 and 45% of horses either improved or did not change their earnings per start and performance index, respectively. Data show that lag screw fixation is successful at restoring ability to race in horses suffering from dorsal cortical stress fractures. © 2010 EVJ Ltd.

  3. Emergency and crisis management: critical incident stress management for first responders and business organisations.

    Science.gov (United States)

    Guenthner, Daniel H

    2012-01-01

    A literature review was performed on critical incident stress after September 11th, 2001 (9/11), and Hurricanes Katrina and Rita, which focused on the need to implement a holistic critical incident stress management programme for first responders and business organisations. Critical incident stress management is required to handle acute stress and other distress in the face of natural or man-made disasters, including terrorist attacks. A holistic approach to community resilience through a well-planned and implemented critical incident stress management programme has been shown in the literature to promote self-help and self-efficacy of individuals and organisations. The interventions and programme elements defined clearly show how a number of different intervention and prevention strategies will promote business and community resilience and also self-efficacy in a culturally-diverse community and organisation. Implementing a critical incident stress management programme within a responding business organisation is critical because of the fact that first responders are the most susceptible every day to exposure to critical incidents that will affect their mental health; and business employees will suffer some of the same maladies as first responders in the event of a disaster or crisis. Utilising the framework provided, a holistic critical incident stress management programme can be implemented to help reduce the effects of burnout, absenteeism, acute stress, post-traumatic stress, substance use and traumatic stress, and to work to promote community resilience and toughen individuals against the effects of stress. Taking care of the needs of the employees of a business organisation, and of those of first responders, is clearly required.

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

    Science.gov (United States)

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

    2017-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Soundarrajan Dhanasekaran

    2018-01-01

    Conclusion: TKA with long stem gives excellent outcome, irrespective of severity of arthritis associated with stress fracture. By restoring limb alignment and bypassing the fracture site, it facilitates fracture healing. Early detection and prompt intervention is necessary to prevent the progression to recalcitrant non-union or malunion.

  6. Anterior tension band plating for anterior tibial stress fractures in high-performance female athletes: a report of 4 cases

    NARCIS (Netherlands)

    Borens, Olivier; Sen, Milan K.; Huang, Russel C.; Richmond, Jeffrey; Kloen, Peter; Jupiter, Jesse B.; Helfet, David L.

    2006-01-01

    Stress fracture of the anterior tibial cortex is an extremely challenging fracture to treat, especially in the high-performance female athlete who requires rapid return to competition. Previous reports have not addressed treating these fractures in the world-class athlete with anterior plating. We

  7. Rockfall triggering by cyclic thermal stressing of exfoliation fractures

    Science.gov (United States)

    Collins, Brian D.; Stock, Greg M.

    2016-01-01

    Exfoliation of rock deteriorates cliffs through the formation and subsequent opening of fractures, which in turn can lead to potentially hazardous rockfalls. Although a number of mechanisms are known to trigger rockfalls, many rockfalls occur during periods when likely triggers such as precipitation, seismic activity and freezing conditions are absent. It has been suggested that these enigmatic rockfalls may occur due to solar heating of rock surfaces, which can cause outward expansion. Here we use data from 3.5 years of field monitoring of an exfoliating granite cliff in Yosemite National Park in California, USA, to assess the magnitude and temporal pattern of thermally induced rock deformation. From a thermodynamic analysis, we find that daily, seasonal and annual temperature variations are sufficient to drive cyclic and cumulative opening of fractures. Application of fracture theory suggests that these changes can lead to further fracture propagation and the consequent detachment of rock. Our data indicate that the warmest times of the day and year are particularly conducive to triggering rockfalls, and that cyclic thermal forcing may enhance the efficacy of other, more typical rockfall triggers.

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

    International Nuclear Information System (INIS)

    Sequera, C.; Gordon, H.

    2003-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Ubiratan Stefani de Oliveira

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

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

    Science.gov (United States)

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

    2016-01-01

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

  11. Updated fracture incidence rates for the US version of FRAX (registered trademark)

    Science.gov (United States)

    Evaluation of results produced by the US version of FRAX (trademarked) indicates that this tool overestimates the likelihood of major osteoporotic fracture. In an attempt to correct this, we updated underlying baseline fracture rates for the model. We used US hospital discharge data from 2006 to ca...

  12. Peak incidence of distal radius fractures due to ice skating on natural ice in The Netherlands

    NARCIS (Netherlands)

    van Lieshout, Arno P. W.; van Manen, Christiaan J.; du Pré, Karel J.; Kleinlugtenbelt, Ydo V.; Poolman, Rudolf W.; Goslings, J. Carel; Kloen, Peter

    2010-01-01

    An increase of distal radius fractures was seen in 2009 when an extended cold spell allowed natural ice skating in Amsterdam. This resulted in overload of our Emergency Departments and operating rooms. This study reports patient and fracture characteristics of these injuries. We also determined

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

    Energy Technology Data Exchange (ETDEWEB)

    Liu, H.H.; Rutqvist, J.

    2009-10-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-07-15

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

  15. The impact of incident fractures on health-related quality of life: 5 years of data from the Canadian Multicentre Osteoporosis Study.

    Science.gov (United States)

    Papaioannou, A; Kennedy, C C; Ioannidis, G; Sawka, A; Hopman, W M; Pickard, L; Brown, J P; Josse, R G; Kaiser, S; Anastassiades, T; Goltzman, D; Papadimitropoulos, M; Tenenhouse, A; Prior, J C; Olszynski, W P; Adachi, J D

    2009-05-01

    Using prospective data from the Canadian Multicentre Osteoporosis Study (CaMos), we compared health utilities index (HUI) scores after 5 years of follow-up among participants (50 years and older) with and without incident clinical fractures. Incident fractures had a negative impact on HUI scores over time. This study examined change in health-related quality of life (HRQL) in those with and without incident clinical fractures as measured by the HUI. The study cohort was 4,820 women and 1,783 men (50 years and older) from the CaMos. The HUI was administered at baseline and year 5. Participants were sub-divided into incident fracture groups (hip, rib, spine, forearm, pelvis, other) and were compared with those without these fractures. The effects of both time and fracture type on HUI scores were examined in multivariable regression analyses. Men and women with hip fractures, compared to those without, had lower HUI measures that ranged from -0.05 to -0.25. Both women and men with spine fractures had significant deficits on the pain attributes (-0.07 to -0.12). In women, self-care (-0.06), mobility and ambulation (-0.05) were also negatively impacted. Women with rib fractures had deficits similar to women with spine fractures, and these effects persisted over time. In men, rib fractures did not significantly affect HUI scores. Pelvic and forearm fractures did not substantially influence HUI scores. The HUI was a sensitive measure of HRQL change over time. These results will inform economic analyses evaluating osteoporosis therapies.

  16. Fatigue and insufficiency fractures

    International Nuclear Information System (INIS)

    Lodwick, G.S.; Rosenthal, D.I.; Kattapuram, S.V.; Hudson, T.M.

    1987-01-01

    The incidence of stress fracture is increasing. In our younger society this is due largely to a preocupation with physical conditioning, but in our elderly population it is due to improved recognition and better methods of detection and diagnosis. Stress fracture of the elderly is an insufficiency fracture which occurs in the spine, the pelvis, the sacrum and other bones afflicted with disorders which cause osteopenia. Stress fracture is frequently misdiagnosed as a malignant lesion of bone resulting in biopsy. Scintiscanning provides the greatest frequency of detection, while computed tomography often provides the definitive diagnosis. With increased interest and experience a better insight into the disease has been achieved, and what was once thought of as a simple manifestation of mechanical stress is now known to be an orderly, complex pattern of physiological changes in bone which conform to a model by Frost. The diffuse nature of these changes can be recognized by scintigraphy, radiography and magnetic resonance imaging. 27 refs.; 8 figs

  17. Tension band plating of a nonunion anterior tibial stress fracture in an athlete.

    Science.gov (United States)

    Merriman, Jarrad A; Villacis, Diego; Kephart, Curtis J; Rick Hatch, George F

    2013-07-01

    The authors present a rare technique of tension band plating of the anterior tibia in the setting of a nonunion stress fracture. Surgical management with an intramedullary nail is a viable and proven option for treating such injuries. However, in treating elite athletes, legitimate concerns exist regarding the surgical disruption of the extensor mechanism and the risk of anterior knee pain associated with intramedullary nail use. The described surgical technique demonstrates the use of tension band plating as an effective treatment of delayed union and nonunion anterior tibial stress fractures in athletes without the potential risks of intramedullary nail insertion. Copyright 2013, SLACK Incorporated.

  18. Dealing Collectively with Critical Incident Stress Reactions in High Risk Work Environments

    DEFF Research Database (Denmark)

    Müller-Leonhardt, Alice; Strøbæk, Pernille Solveig; Vogt, joachim

    2015-01-01

    organisations. Indeed, we found that the CISM programme once integrated within the socio-cultural patterns of this specific working environment enhanced not only individual feelings of being supported but also organisational safety culture. Keywords: coping; safety culture; critical incident stress management......aim of this paper is to shift the representation of coping patterns within high risk occupations to an existential part of cultural pattern and social structure, which characterises high reliability organisations. Drawing upon the specific peer model of critical incident stress management (CISM......), in which qualified operational peers support colleagues who experienced critical incident stress, the paper discusses critical incident stress management in air traffic control. Our study revealed coping patterns that co-vary with the culture that the CISM programme fostered within this specific high...

  19. Practical application of fracture mechanics with consideration of multiaxiality of stress state to degraded nuclear piping

    International Nuclear Information System (INIS)

    Kussmaul, K.; Blind, D.; Herter, K.H.; Eisele, U.; Schuler, X.

    1995-01-01

    Within the scope of a research project nuclear piping components (T-branches and elbows) with dimensions like the primary coolant lines of PWR plants were investigated. In addition to the experimental full scale tests, extensive numerical calculations by means of the finite element method (FEM) as well as fracture mechanics analyses were performed. The applicability of these methods was verified by comparison with the experimental results. The calculation of fracture mechanics parameters as well as the calculated component stress enabled a statement on crack initiation. The failure behavior could be evaluated by means of the multiaxiality of stress state in the ligament (gradient of the quotient of the multiaxiality of stress state q). With respect to practical application on other pressurized components it is shown how to use the procedure (e.g. in a LBB analysis). A quantitative assessment with regard to crack initiation is possible by comparison of the effective crack initiation value J ieff with the calculated component stress. If the multiaxiality of stress state and the q gradient in the ligament of the fracture ligament of the fracture mechanics specimen and the pressurized component to be evaluated is comparable a quantitative assessment is possible as for crack extension and maximum load. If there is no comparability of the gradients a qualitative assessment is possible for the failure behavior

  20. Increased sclerostin associated with stress fracture of the third metacarpal bone in the Thoroughbred racehorse.

    Science.gov (United States)

    Hopper, N; Singer, E; Henson, F

    2018-01-01

    The exact aetiology and pathogenesis of microdamage-induced long bone fractures remain unknown. These fractures are likely to be the result of inadequate bone remodelling in response to damage. This study aims to identify an association of osteocyte apoptosis, the presence of osteocytic osteolysis, and any alterations in sclerostin expression with a fracture of the third metacarpal (Mc-III) bone of Thoroughbred racehorses. A total of 30 Mc-III bones were obtained; ten bones were fractured during racing, ten were from the contralateral limb, and ten were from control horses. Each Mc-III bone was divided into a fracture site, condyle, condylar groove, and sagittal ridge. Microcracks and diffuse microdamage were quantified. Apoptotic osteocytes were measured using TUNEL staining. Cathepsin K, matrix metalloproteinase-13 (MMP-13), HtrA1, and sclerostin expression were analyzed. In the fracture group, microdamage was elevated 38.9% (sd 2.6) compared with controls. There was no difference in the osteocyte number and the percentage of apoptotic cells between contralateral limb and unraced control; however, there were significantly fewer apoptotic cells in fractured samples (p fractured samples, sclerostin expression was significantly higher (p bones that have fractured during racing. In this study, this is not associated with osteocyte apoptosis or osteocytic osteolysis. The finding of increased sclerostin in the region of the fracture suggests that this protein may be playing a key role in the regulation of bone microdamage during stress adaptation. Cite this article: Bone Joint Res 2018;7:94-102. © 2018 Hopper et al.

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

    International Nuclear Information System (INIS)

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

    2010-01-01

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

  2. Biomarkers of cardiovascular stress and incident chronic kidney disease.

    Science.gov (United States)

    Ho, Jennifer E; Hwang, Shih-Jen; Wollert, Kai C; Larson, Martin G; Cheng, Susan; Kempf, Tibor; Vasan, Ramachandran S; Januzzi, James L; Wang, Thomas J; Fox, Caroline S

    2013-11-01

    Growth differentiation factor-15 (GDF-15), soluble ST2 (sST2), and high-sensitivity troponin I (hsTnI) are emerging predictors of adverse clinical outcomes. We examined whether circulating concentrations are related to the development of kidney disease in the community. Plasma GDF-15, sST2, and hsTnI concentrations were measured in 2614 Framingham Offspring cohort participants (mean age 57 years, 54% women) at the sixth examination cycle (1995-1998). Associations of biomarkers with incident chronic kidney disease [CKD, eGFR statistically significant in primary analyses. Participants were followed over a mean of 9.5 years. Higher plasma GDF-15 was associated with incident CKD [multivariable-adjusted odds ratio (OR) 1.9 per 1-U increase in log-GDF-15, 95% CI 1.6-2.3, P statistic increased from 0.826 to 0.845 (P = 0.0007), and categorical net reclassification was 6.3% (95% CI, 2.7-9.9%). Higher circulating GDF-15 is associated with incident renal outcomes and improves risk prediction of incident CKD. These findings may provide insights into the mechanisms of renal injury.

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

    Science.gov (United States)

    Robertson, Michael; Gilley, Jasen; Nicholas, Richard

    2016-11-01

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

  4. Prediction of tectonic stresses and fracture networks with geomechanical reservoir models

    International Nuclear Information System (INIS)

    Henk, A.; Fischer, K.

    2014-09-01

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

  5. Prediction of tectonic stresses and fracture networks with geomechanical reservoir models

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-09-15

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

  6. Probabilistic fracture mechanics analysis of reactor vessel for pressurized thermal shock: the effect of residual stress and fracture toughness

    International Nuclear Information System (INIS)

    Jung, Sung Gyu; Jin, Tae Eun; Jhung, Myung Jo; Choi, Young Hwan

    2003-01-01

    The structural integrity of the reactor vessel with the approaching end of life must be assured for pressurized thermal shock. The regulation specifies the screening criteria for this and requires that specific analysis be performed for the reactor vessel which is anticipated to exceed the screening criteria at the end of plant life. In case the screening criteria is exceeded by the deterministic analysis, probabilistic analysis must be performed to show that failure probability is within the limit. In this study, probabilistic fracture mechanics analysis of the reactor vessel for pressurized thermal shock is performed and the effects of residual stress and master curve on the failure probability are investigated

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

    Directory of Open Access Journals (Sweden)

    Keishi Maruo

    2015-01-01

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

  8. Rib stress fractures among rowers: definition, epidemiology, mechanisms, risk factors and effectiveness of injury prevention strategies.

    Science.gov (United States)

    McDonnell, Lisa K; Hume, Patria A; Nolte, Volker

    2011-11-01

    Rib stress fractures (RSFs) can have serious effects on rowing training and performance and accordingly represent an important topic for sports medicine practitioners. Therefore, the aim of this review is to outline the definition, epidemiology, mechanisms, intrinsic and extrinsic risk factors, injury management and injury prevention strategies for RSF in rowers. To this end, nine relevant books, 140 journal articles, the proceedings of five conferences and two unpublished presentations were reviewed after searches of electronic databases using the keywords 'rowing', 'rib', 'stress fracture', 'injury', 'mechanics' and 'kinetics'. The review showed that RSF is an incomplete fracture occurring from an imbalance between the rate of bone resorption and the rate of bone formation. RSF occurs in 8.1-16.4% of elite rowers, 2% of university rowers and 1% of junior elite rowers. Approximately 86% of rowing RSF cases with known locations occur in ribs four to eight, mostly along the anterolateral/lateral rib cage. Elite rowers are more likely to experience RSF than nonelite rowers. Injury occurrence is equal among sweep rowers and scullers, but the regional location of the injury differs. The mechanism of injury is multifactorial with numerous intrinsic and extrinsic risk factors contributing. Posterior-directed resultant forces arising from the forward directed force vector through the arms to the oar handle in combination with the force vector induced by the scapula retractors during mid-drive, or repetitive stress from the external obliques and rectus abdominis in the 'finish' position, may be responsible for RSF. Joint hypomobility, vertebral malalignment or low bone mineral density may be associated with RSF. Case studies have shown increased risk associated with amenorrhoea, low bone density or poor technique, in combination with increases in training volume. Training volume alone may have less effect on injury than other factors. Large differences in seat and handle

  9. Asymptomatic Strut Fracture in DeBakey-Surgitool Aortic Valves: Incidence, Management, and Metallurgic Aspects

    OpenAIRE

    Von Der Emde, Jürgen; Eberlein, Ulrich; Breme, Jürgen

    1990-01-01

    From August 1971 through November 1972, we implanted 62 Model 2 DeBakey-Surgitool aortic valve prostheses in 62 patients, 4 of whom later had clinically asymptomatic strut fractures. In 1 case, the patient died suddenly, and autopsy revealed detachment of the ball-cage; in each of the other 3 cases, fractures of 2 struts close to the base of the prosthesis were diagnosed fluoroscopically, and the patients underwent successful reoperation. The interval between implantation and reoperation rang...

  10. The inclusion of weld residual stress in fracture margin assessments of embrittled nuclear reactor pressure vessels

    International Nuclear Information System (INIS)

    Dickson, T.L.; Bass, B.R.; McAfee, W.J.

    1998-01-01

    Analyses were performed to determine the impact of weld residual stresses in a reactor pressure vessel (RPV) on (1) the generation of pressure temperature (P-T) curves required for maintaining specified fracture prevention margins during nuclear plant startup and shutdown, and (2) the conditional probability of vessel failure due to pressurized thermal shock (PTS) loading. The through wall residual stress distribution in an axially oriented weld was derived using measurements taken from a shell segment of a canceled RPV and finite element thermal stress analyses. The P-T curve derived from the best estimate load analysis and a t / 8 deep flaw, based on K Ic , was less limiting than the one derived from the current methodology prescribed in the ASME Boiler and Pressure Vessel Code. The inclusion of the weld residual stresses increased the conditional probability of cleavage fracture due to PTS loading by a factor ranging from 2 to 4

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

    Science.gov (United States)

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

    2018-05-01

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

  12. Ten-year incidence and risk factors of bone fractures in a cohort of treated HIV1-infected adults

    Science.gov (United States)

    Collin, Fidéline; Duval, Xavier; Lemoing, Vincent; Piroth, Lionel; Al Kaied, Firas; Massip, Patrice; Villes, Virginie; Chêne, Geneviève; Raffi, François

    2009-01-01

    In the ANRS CO8 APROCO-COPILOTE cohort of patients treated with combination antiretroviral therapy since 1997–1999, the incidence density of bone fractures was 3.3 for 1,000 patient-years (95% CI: 2.0–4.6). Rate was 2.9-fold (95% CI: 1.3–6.5) higher among patients with excessive alcohol consumption and 3.6-fold (95% CI: 1.6–8.1) higher in those with Hepatitis C virus (HCV) co-infection. Specific monitoring of HCV/HIV-coinfected patients and active promotion of alcohol cessation should be recommended for the prevention of bone fractures. PMID:19300202

  13. Heat induced fracturing of rock in an existing uniaxial stress field

    International Nuclear Information System (INIS)

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

    1986-01-01

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

  14. Risk factors associated with incident clinical vertebral and nonvertebral fractures in postmenopausal women: the Canadian Multicentre Osteoporosis Study (CaMos).

    Science.gov (United States)

    Papaioannou, Alexandra; Joseph, Lawrence; Ioannidis, George; Berger, Claudie; Anastassiades, Tassos; Brown, Jacques P; Hanley, David A; Hopman, Wilma; Josse, Robert G; Kirkland, Susan; Murray, Timothy M; Olszynski, Wojciech P; Pickard, Laura; Prior, Jerilynn C; Siminoski, Kerry; Adachi, Jonathan D

    2005-05-01

    Utilizing data from the Canadian Multicentre Osteoporosis Study (CaMos), we examined the association between potential risk factors and incident vertebral and nonvertebral fractures. A total of 5,143 postmenopausal women were enrolled. Information collected during the study included data from the CaMos baseline and annually mailed fracture questionnaires, the Short Form 36 (SF-36), the Health Utilities Index, and physical measurements. Participants were followed for 3 years. Postmenopausal women were classified into four groups according to their incident fracture status since baseline: those without a new fracture; those with a new clinically recognized vertebral fracture; those with an incident nonvertebral fracture at the wrist, hip, humerus, pelvis, or ribs (main nonvertebral fracture group); and those with any new nonvertebral fracture (any-nonvertebral-fracture group). We performed multivariate Cox proportional hazard analysis using all possible risk factors to determine the association between risk factors and the time to the first minimal trauma fracture. Best predictive models were also determined using variables that were included in the full models. The Bayesian information criterion was used for model selection. For all analyses, relative risks and associated 95% confidence intervals were calculated. During the follow-up period, 34, 163, and 280 women developed a vertebral, a main nonvertebral, or any nonvertebral fracture, respectively. The best predictive models indicated that a five point lower quality of life as measured by the SF-36 physical component summary score was associated with relative risks of 1.21 (95% CI, 1.02 to 1.44), 1.17 (95% CI, 1.07 to 1.28), and 1.19 (95% CI, 1.11 to 1.27) for incident vertebral, main nonvertebral, and all nonvertebral fractures, respectively. In addition, for a one standard deviation (SD=0.12) lower femoral neck BMD, the relative risks for incident vertebral, main nonvertebral, and any nonvertebral fractures

  15. A fracture mechanics model for iodine stress corrosion crack propagation in Zircaloy tubing

    International Nuclear Information System (INIS)

    Crescimanno, P.J.; Campbell, W.R.; Goldberg, I.

    1984-01-01

    A fracture mechanics model is presented for iodine-induced stress corrosion cracking in Zircaloy tubing. The model utilizes a power law to relate crack extension velocity to stress intensity factor, a hyperbolic tangent function for the influence of iodine concentration, and an exponential function for the influence of temperature and material strength. Comparisons of predicted to measured failure times show that predicted times are within a factor of two of the measured times for a majority of the specimens considered

  16. Prevention of brittle fracture of steel structures by controlling the local stress and strain fields

    Directory of Open Access Journals (Sweden)

    Moyseychik Evgeniy Alekseevich

    Full Text Available In the article the author offers a classification of the methods to increase the cold resistance of steel structural shapes with a focus on the regulation of local fields of internal stresses and strains to prevent brittle fracture of steel structures. The need of a computer thermography is highlighted not only for visualization of temperature fields on the surface, but also to control the fields of residual stresses and strains in a controlled element.

  17. Adductor insertion avulsion syndrome with stress fracture of femoral shaft: MRI findings

    International Nuclear Information System (INIS)

    Lawande, M.A.; Sankhe, S.; Pungavkar, S.A.; Patkar, D.P.

    2007-01-01

    Full text: Chronic vague hip pain may be caused by stress-related injury in the proximal or mid-femoral diaphysis. This has been described as an entity called adductor insertion avulsion syndrome, or thigh splints. In the appropriate clinical setting, the radiologist interpreting the magnetic resonance imaging must be aware of this condition as its imaging findings are subtle. The diagnosis will help the clinician plan the appropriate management. Magnetic resonance imaging can also depict the complications such as stress fracture

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

    Science.gov (United States)

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

    2009-12-01

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

  19. Risk Stratification of Stress Fractures and Prediction of Return to Duty

    Science.gov (United States)

    2015-12-01

    SUBJECT TERMS bone microarchitecture, HRpQCT, race, gender , sex, bone mineral density, vBMD, bone geometry, stress fracture 16. SECURITY...are collaborating with local sports medicine physicians, coaches, and athletic trainers to continue recruiting effectively (Task 3, objective 3). We

  20. Rib stress fractures among rowers: a systematic review on return to sports, risk factors and prevention

    NARCIS (Netherlands)

    D'Ailly, Philip N.; Sluiter, Judith K.; Kuijer, Paul P.

    2016-01-01

    Rib stress fractures (RSFs) are injuries frequently sustained by elite rowers with an injury rate of 8-16% over the course of a rowing career, resulting in negative effects on training and performance. For clinical management, the aim of this review was to describe time to return to sports,

  1. Prediction of minimum UO2 particle size based on thermal stress initiated fracture model

    International Nuclear Information System (INIS)

    Corradini, M.

    1976-08-01

    An analytic study was employed to determine the minimum UO 2 particle size that could survive fragmentation induced by thermal stresses in a UO 2 -Na Fuel Coolant Interaction (FCI). A brittle fracture mechanics approach was the basis of the study whereby stress intensity factors K/sub I/ were compared to the fracture toughness K/sub IC/ to determine if the particle could fracture. Solid and liquid UO 2 droplets were considered each with two possible interface contact conditions; perfect wetting by the sodium or a finite heat transfer coefficient. The analysis indicated that particles below the range of 50 microns in radius could survive a UO 2 -Na fuel coolant interaction under the most severe temperature conditions without thermal stress fragmentation. Environmental conditions of the fuel-coolant interaction were varied to determine the effects upon K/sub I/ and possible fragmentation. The underlying assumptions of the analysis were investigated in light of the analytic results. It was concluded that the analytic study seemed to verify the experimental observations as to the range of the minimum particle size due to thermal stress fragmentation by FCI. However the method used when the results are viewed in light of the basic assumptions indicates that the analysis is crude at best, and can be viewed as only a rough order of magnitude analysis. The basic complexities in fracture mechanics make further investigation in this area interesting but not necessarily fruitful for the immediate future

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

    Science.gov (United States)

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

    2008-03-01

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

  3. Stress Fracture of the Pubic Ramus in a Female Long Distance Runner: A Case Report

    Directory of Open Access Journals (Sweden)

    Seçkin Şenışık

    2017-06-01

    Stress fractures of the pelvis should be included in the differential diagnosis of female distance runners who have prolonged groin pain increasing with exercise. Detailed medical history, physical examination, blood tests, and radiological images are keys to reach certain diagnosis. Treatment plan should include risk factor analysis and progressive training programs.

  4. The effect of through-thickness compressive stress on mode II interlaminar fracture toughness

    NARCIS (Netherlands)

    Catalanotti, G.; Furtado, C.; Scalici, T.; Pitarresi, G.; van der Meer, F.P.; Camanho, PP

    2017-01-01

    The effect of through-thickness compressive stress on mode II interlaminar fracture toughness is investigated experimentally and replicated numerically. The modified Transverse Crack Tensile specimen recently proposed by the authors is used, together with an experimental device designed to apply

  5. Incidence of second cervical vertebral fractures far surpassed the rate predicted by the changing age distribution and growth among elderly persons in the United States (2005-2008).

    Science.gov (United States)

    Zusman, Natalie L; Ching, Alexander C; Hart, Robert A; Yoo, Jung U

    2013-04-20

    Nationwide epidemiological cohort study. To characterize the incidence of second cervical vertebral (C2) fractures by age and geographical region among the elderly Medicare population and to elucidate if the rate changed in the years 2005 to 2008. Recent publications hypothesized that the rate of cervical vertebral fractures may be increasing. To date, there are no published nationwide reports describing the incidence and demographics of these injuries in the elderly US population. Incidence of C2 fracture in the years 2005 to 2008 was determined by querying PearlDiver Technologies, Inc. (Warsaw, IN), a commercially available database, using International Classification of Diseases code 805.02. Rates were calculated using the PearlDiver reported person-counts as the numerator and the Center for Medicare and Medicare Services midyear population file as the denominator, and reported per 10,000 person-years (10,000 p-y). The age and geographical distributions of fractures were examined. Variability in rates was analyzed using the mean, standard deviation, 95% confidence intervals, χ tests, and Pearson correlation coefficients. Although the elderly population increased by 6% between 2005 and 2008, the annual incidence of C2 fracture rose by 21%, from 1.58 to 1.91 per 10,000 p-y, trending upward in a straight-line function (r = 0.999, P = 0.0006). The incidence of fracture varied between age groups; however, an increase was observed in all age groups. Persons aged 65 to 74 years (the youngest age group) experienced the lowest incidence (0.63 in 2005 to 0.71 in 2008), and the rate of increase was the smallest among the age groups examined (13%). Persons aged 85 and older demonstrated the highest incidence (4.36-5.67) and the greatest increase (30%). From 2005 to 2008, the overall incidence of C2 fracture rose at a rate that was 3.5 times faster than the elderly population growth.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2017-07-01

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

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

    International Nuclear Information System (INIS)

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

    2017-01-01

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

  8. The application of fracture mechanics in thermally stressed structures

    International Nuclear Information System (INIS)

    Cesari, F.; Maitan, A.; Hellen, T.K.

    1981-03-01

    There is considerable interest in calculating stress intensity factors at crack tips in thermally stressed structures, particularly in the power generation industry where the safe operation of both conventional and nuclear plant is founded on rigorous safety cases. Analytical methods to study such problems are of limited scope, although they can be extended by introducing numerical techniques. Purpose built numerical methods, however, offer a much greater and more accurate solution capability and in particular the finite element method is well advanced. Such methods are described, including how stress intensity factors can be obtained from the finite element results. They are then applied to a range of thermally stressed problems including plates with central cracks and cylinders with axial and circumferential cracks. Both steady state and transient temperature distributions arising from typical thermal shocks are considered. (author)

  9. Number of recent stressful life events and incident cardiovascular disease: Moderation by lifetime depressive disorder.

    Science.gov (United States)

    Berntson, Jessica; Patel, Jay S; Stewart, Jesse C

    2017-08-01

    We investigated whether number of recent stressful life events is associated with incident cardiovascular disease (CVD) and whether this relationship is stronger in adults with a history of clinical depression. Prospective data from 28,583 U.S. adults (mean age=45years) initially free of CVD who participated in Waves 1 (2001-2002) and 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were examined. Number of past-year stressful life events (Wave 1), lifetime depressive disorder (Wave 1), and incident CVD (Wave 2) were determined by structured interviews. There were 1069 cases of incident CVD. Each additional stressful life event was associated with a 15% increased odds of incident CVD [Odds Ratio (OR)=1.15, 95% Confidence Interval (CI): 1.11, 1.19]. As hypothesized, a stressful life events by lifetime depressive disorder interaction was detected (P=0.003). Stratified analyses indicated that stressful life events had a stronger association with incident CVD among adults with (OR=1.18, 95% CI: 1.10, 1.27, n=4908) versus without (OR=1.10, 95% CI: 1.07, 1.14, n=23,675) a lifetime depressive disorder. Our findings suggest that a greater number of recent stressful life events elevate the risk of new-onset CVD and that this risk is potentiated in adults with a history of clinical depression. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Stronger back muscles reduce the incidence of vertebral fractures: a prospective 10 year follow-up of postmenopausal women.

    Science.gov (United States)

    Sinaki, M; Itoi, E; Wahner, H W; Wollan, P; Gelzcer, R; Mullan, B P; Collins, D A; Hodgson, S F

    2002-06-01

    The long-term protective effect of stronger back muscles on the spine was determined in 50 healthy white postmenopausal women, aged 58-75 years, 8 years after they had completed a 2 year randomized, controlled trial. Twenty-seven subjects had performed progressive, resistive back-strengthening exercises for 2 years and 23 had served as controls. Bone mineral density, spine radiographs, back extensor strength, biochemical marker values, and level of physical activity were obtained for all subjects at baseline, 2 years, and 10 years. Mean back extensor strength (BES) in the back-exercise (BE) group was 39.4 kg at baseline, 66.8 kg at 2 years (after 2 years of prescribed exercises), and 32.9 kg at 10 years (8 years after cessation of the prescribed exercises). Mean BES in the control (C) group was 36.9 kg at baseline, 49.0 kg at 2 years, and 26.9 kg at 10 years. The difference between the two groups was still statistically significant at 10 year follow-up (p = 0.001). The difference in bone mineral density, which was not significant between the two groups at baseline and 2 year follow-up, was significant at 10 year follow-up (p = 0.0004). The incidence of vertebral compression fracture was 14 fractures in 322 vertebral bodies examined (4.3%) in the C group and 6 fractures in 378 vertebral bodies examined (1.6%) in the BE group (chi-square test, p = 0.0290). The relative risk for compression fracture was 2.7 times greater in the C group than in the BE group. To our knowledge, this is the first study reported in the literature demonstrating the long-term effect of strong back muscles on the reduction of vertebral fractures in estrogen-deficient women.

  11. Asymptomatic strut fracture in DeBakey-Surgitool aortic valves: incidence, management, and metallurgic aspects.

    Science.gov (United States)

    Von Der Emde J, J; Eberlein, U; Breme J, J

    1990-01-01

    From August 1971 through November 1972, we implanted 62 Model 2 DeBakey-Surgitool aortic valve prostheses in 62 patients, 4 of whom later had clinically asymptomatic strut fractures. In 1 case, the patient died suddenly, and autopsy revealed detachment of the ball-cage; in each of the other 3 cases, fractures of 2 struts close to the base of the prosthesis were diagnosed fluoroscopically, and the patients underwent successful reoperation. The interval between implantation and reoperation ranged from 11 months to 16 years, 9 months. In 1 patient, retrospective study of chest radiographs revealed that the fracture had been present for 2(1/2) years. Larger valves (>/= A6) were affected significantly more often than smaller ones. We performed metallurgic analysis of 1 prosthesis: results revealed strut wear from fatigue cracking and secondary abrasion. Strut fracture was also promoted by suspension of the cage at right angles to the prosthetic ring and by use of a pyrolytic carbon ball in a titanium cage (i.e., an occluder harder than its holder). Patients with DeBakey-Surgitool aortic valve prostheses should undergo annual radiologic examinations to enable early detection of strut fractures. Prophylactic valve replacement is not indicated.

  12. Are Elite Female Soccer Athletes at Risk for Disordered Eating Attitudes, Menstrual Dysfunction, and Stress Fractures?

    Science.gov (United States)

    Prather, Heidi; Hunt, Devyani; McKeon, Kathryn; Simpson, Scott; Meyer, E Blair; Yemm, Ted; Brophy, Robert

    2016-03-01

    To determine the prevalence of stress fractures, menstrual dysfunction and disordered eating attitudes in elite female soccer athletes. Cross-sectional descriptive study. Female soccer athletes were recruited from a national level youth soccer club, an NCAA Division I university team, and a women's professional team. Two hundred twenty female soccer athletes with a mean age of 16.4 ± 4 years and BMI of 20.8 ± 2 kg/m(2) completed the study, representing all athletes from the included teams. One-time surveys completed by the athletes. Height and weight were recorded, and body mass index (BMI) was calculated for each athlete. Athletes reported age of menarche, history of missing 3 or more menses within a 12-month period and stress fracture. The Eating Attitudes Test (EAT-26) was used to assess the athlete's body perception and attitudes toward eating. Of the 220 soccer athletes, 3 athletes (1.6%) had a low BMI for their age, and 19 (8.6%) reported stress fractures of the lower extremity. Among athletes who had reached menarche, the average onset was 13 + 1 year; menstrual dysfunction were present in 21 (19.3%). On the EAT-26, 1 player scored in the high risk range (>20) and 17 (7.7%) scored in the intermediate risk range (10-19) for eating disorders. Athletes with an EAT-26 score ≥ 10 points had a significantly higher prevalence of menstrual dysfunction in the past year compared to athletes with an EAT-26 score of less than 10 (P = .02). Elite female soccer athletes are susceptible to stress fractures and menstrual dysfunction and have delayed onset of menarche despite normal BMI and appropriate body perception and attitudes towards eating. Further studies are needed to better understand stress fracture risk in female soccer athletes and in other team sports to determine how these findings relate to long-term bone health in this population. Copyright © 2016. Published by Elsevier Inc.

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

    Directory of Open Access Journals (Sweden)

    Shigekazu eKusumoto

    2014-05-01

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

  14. Vitamin D sufficiency is associated with low incidence of limb and vertebral fractures in community-dwelling elderly Japanese women: the Muramatsu Study.

    Science.gov (United States)

    Nakamura, K; Saito, T; Oyama, M; Oshiki, R; Kobayashi, R; Nishiwaki, T; Nashimoto, M; Tsuchiya, Y

    2011-01-01

    Data on the association between vitamin D status and osteoporotic fracture in Asians are sparse. We conducted a 6-year cohort study of 773 community-dwelling elderly Japanese women and found that serum 25-hydroxyvitamin D (25(OH)D) ≥ 71 nmol/L was associated with a reduced risk of osteoporotic limb and vertebral fractures. Data on the association between vitamin D status and osteoporotic fracture in Asians are sparse. This study aimed to clarify the association between vitamin D and other markers of nutritional status with the incidence of fracture in elderly Japanese women. We conducted a cohort study with a 6-year follow-up of 773 community-dwelling women aged 69 years and older. The 6-year follow-up ended in 2009. We assessed serum 25-hydroxyvitamin D, undercarboxylated osteocalcin (an index of vitamin K status), and calcium intake. The primary outcome was incident limb and vertebral fractures. Covariates were forearm bone mineral density (BMD), age, body mass index, osteoporosis treatment, and physical activity. The mean serum 25(OH)D concentration was 60.0 nmol/L. Thirty-seven limb fractures and 14 vertebral fractures occurred in 4,392 person-years. Lower forearm BMD was significantly associated with increased incident fracture (P = 0.0242). The adjusted hazard ratios (HR) of fracture for the first quartile (fracture. Sufficient vitamin D status, i.e., serum 25(OH)D ≥ 71 nmol/L, is associated with low limb and vertebral fracture risk in community-dwelling elderly women.

  15. High incidence of osteoporosis and fractures in an aging post-polio population.

    LENUS (Irish Health Repository)

    Mohammad, Ausaf F

    2009-01-01

    Since the polio epidemic in Ireland in the 1950s, most polio survivors are approaching into the 6th and 7th decade of their lives. There is little data about bone density and risk of fractures in these patients. In 2006, we undertook an audit of post-polio patients attending rheumatology and neurology outpatient clinics in a university teaching hospital. Our aim was to determine the prevalence of osteoporosis (OP), falls and fractures and to evaluate the association of bone density with other potential contributing factors to OP.

  16. On the fracture of human dentin: Is it stress- orstrain-controlled?

    Energy Technology Data Exchange (ETDEWEB)

    Nalla, R.K.; Kinney, J.H.; Ritchie, R.O.

    2006-02-01

    Despite substantial clinical interest in the fracture resistance of human dentin, there is little mechanistic information in archival literature that can be usefully used to model such fracture. In fact, although the fracture event indent in, akin to other mineralized tissues like bone, is widely believed to be locally strain-controlled, there has never been any scientific proof to support this belief. The present study seeks to address this issue through the use of a novel set of in vitro experiments in Hanks' balanced salt solution involving a double-notched bend test geometry, which is designed to discern whether the critical failure events involved in the onset of fracture are locally stress- or strain-controlled. Such experiments are further used to characterize the notion of ''plasticity'' in dentin and the interaction of cracks with the salient microstructural features. It is observed that fracture in dentin is indeed locally strain-controlled and that the presence of dentinal tubules does not substantially affect this process of crack initiation and growth. The results presented are believed to be critical steps in the development of a micromechanical model for the fracture of human dentin that takes into consideration the influence of both the microstructure and the local failure mode.

  17. Intrapartum sacral stress fracture due to pregnancy-related osteoporosis: a case report.

    Science.gov (United States)

    Oztürk, Gülcan; Külcü, Duygu Geler; Aydoğ, Ece

    2013-01-01

    Low back pain (LBP) and hip pain frequently occur during pregnancy and postpartum period. Although pelvic and mechanic lesions of the soft tissues are most responsible for the etiology, sacral fracture is also one of the rare causes. A 32-year-old primigravid patient presented with LBP and right hip pain which started 3 days after vaginal delivery. Although direct radiographic examination was normal, magnetic resonance imaging of the sacrum revealed sacral stress fracture. Lumbar spine and femoral bone mineral density showed osteoporosis as a risk factor. There were no other risk factors such as trauma, excessive weight gain, and strenuous physical activity. It is considered that the patient had sacral fatigue and insufficiency fracture in intrapartum period. The patient's symptoms subsided in 3 months after physical therapy and rest. In conclusion, sacral fractures during pregnancy and postpartum period, especially resulting from childbirth, are very rare. To date, there are two cases in the literature. In cases who even do not have risk factors related to vaginal delivery such as high birth weight infant and the use of forceps, exc., sacral fracture should be considered in the differential diagnosis of LBP and hip pain started soon after child birth. Pregnancy-related osteoporosis may lead to fracture during vaginal delivery.

  18. The relationship between observed stress corrosion cracking fracture morphology and microstructure in Alloy 600

    International Nuclear Information System (INIS)

    Symons, D.M.; Burke, M.G.; Foster, J.P.

    1997-01-01

    Microstructure is known to influence the stress corrosion cracking (SCC) behavior of Alloy 600 in both hydrogenated water and steam environments. This study evaluated the relative SCC response of a single heat of Alloy 600 as a function of microstructure in a hydrogenated doped-steam environment. The 400 C doped-steam environment was selected for the SCC tests to accelerate cracking. The material was evaluated in three conditions: (1) as-received (2) as-annealed, and (3) as-annealed + 26% deformation. Microstructural characterization was performed using analytical electron microscopy (AEM) techniques for the evaluation of carbide type and morphology, and general structure. Constant displacement (bolt-loaded) compact tension specimens were used to induce SCC. The as-annealed and as-annealed plus cold worked samples had two fracture morphologies: a rough intergranular SCC fracture morphology and a smooth intergranular fracture morphology. The SCC fracture in the as-received specimens was characterized by a classic intergranular morphology at low magnification, consistent with the microstructural evaluation of cross-sectional metallographic samples. More detailed examination revealed a pseudo-intergranular fracture morphology. This pseudo-intergranular morphology appears to be comprised of very fine cleavage-like microfacets. These observations may assist in understanding the difference in SCC fracture morphologies as reported in the open literature

  19. Benchmark on residual stress modeling in fracture mechanics assessment

    International Nuclear Information System (INIS)

    Marie, S.; Deschanels, H.; Chapuliot, S.; Le Delliou, P.

    2014-01-01

    In the frame of development in analytical defect assessment methods for the RSE-M and RCC-MRx codes, new work on the consideration of residual stresses is initiated by AREVA, CEA and EDF. The first step of this work is the realization of a database of F.E. reference cases. To validate assumptions and develop a good practice guideline for the consideration of residual stresses in finite element calculations, a benchmark between AREVA, CEA and EDF is going-on. A first application presented in this paper focuses on the analysis of the crack initiation of aged duplex stainless steel pipes submitted to an increasing pressure loading. Residual stresses are related to pipe fabrication process and act as shell bending condition. Two tests were performed: the first with an internal longitudinal semi-elliptical crack and the second with an external crack. The analysis first focuses on the ability to accurately estimate the measured pressure at the crack initiation of the two tests. For that purpose, the comparison of results obtained with different methods of taking into account the residual stresses (i.e. thermal fields or initial strain field). It then validates post-treatment procedures for J or G determination, and finally compares of the results obtained by the different partners. It is then shown that the numerical models can integrate properly the impact of residual stresses on the crack initiation pressure. Then, an excellent agreement is obtained between the different numerical evaluations of G provided by the participants to the benchmark so that best practice and reference F.E. solutions for residual stresses consideration can be provided based on that work. (authors)

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

    DEFF Research Database (Denmark)

    Bisdom, Kevin; Bertotti, Giovanni; Nick, Hamid

    2016-01-01

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

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

    International Nuclear Information System (INIS)

    Snedden, J.D.

    1977-01-01

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

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

    Directory of Open Access Journals (Sweden)

    G. Pitarresi

    2014-10-01

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

  3. Estimation of In Situ Stresses with Hydro-Fracturing Tests and a Statistical Method

    Science.gov (United States)

    Lee, Hikweon; Ong, See Hong

    2018-03-01

    At great depths, where borehole-based field stress measurements such as hydraulic fracturing are challenging due to difficult downhole conditions or prohibitive costs, in situ stresses can be indirectly estimated using wellbore failures such as borehole breakouts and/or drilling-induced tensile failures detected by an image log. As part of such efforts, a statistical method has been developed in which borehole breakouts detected on an image log are used for this purpose (Song et al. in Proceedings on the 7th international symposium on in situ rock stress, 2016; Song and Chang in J Geophys Res Solid Earth 122:4033-4052, 2017). The method employs a grid-searching algorithm in which the least and maximum horizontal principal stresses ( S h and S H) are varied, and the corresponding simulated depth-related breakout width distribution as a function of the breakout angle ( θ B = 90° - half of breakout width) is compared to that observed along the borehole to determine a set of S h and S H having the lowest misfit between them. An important advantage of the method is that S h and S H can be estimated simultaneously in vertical wells. To validate the statistical approach, the method is applied to a vertical hole where a set of field hydraulic fracturing tests have been carried out. The stress estimations using the proposed method were found to be in good agreement with the results interpreted from the hydraulic fracturing test measurements.

  4. Facebook, stress, and incidence of upper respiratory infection in undergraduate college students.

    Science.gov (United States)

    Campisi, Jay; Bynog, Pamela; McGehee, Hope; Oakland, Joshua C; Quirk, Shannon; Taga, Carlee; Taylor, Morgan

    2012-12-01

    Having a large social network is generally beneficial to health. However, it is unclear how Internet-based social networks might influence health. Chronic stress can have negative health consequences, and some data suggest that Facebook could be a new source of psychological stress. Thus, we examined undergraduate college student perceptions of Facebook use and incidence of upper respiratory infections (URIs). We hypothesized that subjects with more diverse networks (i.e., more friends on Facebook) would have fewer URIs than their less diverse counterparts; that subjects reporting Facebook-induced stress would be more susceptible to URIs; and that subjects with more diverse networks who report Facebook-induced stress would be less susceptible to URIs than subjects with less diverse social networks who reported Facebook-induced stress. In this prospective study, healthy college students completed online questionnaires that assessed use and perceptions of Facebook and technology, and then were interviewed weekly for 10 weeks to track incidence of URI. URI episodes were defined by a symptom-based criterion. The social network size was significantly related to the rate of URI, such that, the larger the social network, the greater the incidence rate of URI. Most (85.7 percent) respondents experienced some degree of Facebook-induced stress. The effects of Facebook-induced stress on incidence of URI varied across the social network size, such that, the impact of stress on the URI incidence rate increased with the size of the social network. These results are largely in contrast to our hypotheses, but clearly suggest an association between Facebook use, psychological stress, and health.

  5. Thermal/moisture-related stresses and fracture behaviour in solid wood members during forced drying

    DEFF Research Database (Denmark)

    Larsen, Finn

    , in particular the stress and cracking that takeplace during kiln-drying. Both experimental and numerical work was carried out so as to obtain knowledge regarding stress, strain, mechano-sorption and crackbehaviours in wood during drying.The investigations aimed also at revealing how drying damagecan best...... of wood without injury to the timber itself. When solid wood products are dried from a green condition down to an average moisture content level close to the service life conditions of the final product, significant moisture-induced stresses and related fracturing can occur. The drying stresses arise...... with a drying history that was generated, to verify a model that was used to simulate disc samples of the same type. The stresses were analyzed so as to clarify whether and when critical stress stateswere encountered during the drying process. The reversibility of the mechano-sorptive strains, i...

  6. Serum 25-hydroxyvitamin D, mortality, and incident cardiovascular disease, respiratory disease, cancers, and fractures: a 13-y prospective population study.

    Science.gov (United States)

    Khaw, Kay-Tee; Luben, Robert; Wareham, Nicholas

    2014-11-01

    Vitamin D is associated with many health conditions, but optimal blood concentrations are still uncertain. We examined the prospective relation between serum 25-hydroxyvitamin D [25(OH)D] concentrations [which comprised 25(OH)D3 and 25(OH)D2] and subsequent mortality by the cause and incident diseases in a prospective population study. Serum vitamin D concentrations were measured in 14,641 men and women aged 42-82 y in 1997-2000 who were living in Norfolk, United Kingdom, and were followed up to 2012. Participants were categorized into 5 groups according to baseline serum concentrations of total 25(OH)D increasing vitamin D category were 1, 0.84 (0.74, 0.94), 0.72 (0.63, 0.81), 0.71 (0.62, 0.82), and 0.66 (0.55, 0.79) (P-trend disease, diabetes, or cancer, HRs for a 20-nmol/L increase in 25(OH)D were 0.92 (0.88, 0.96) (P disease, 0.89 (0.85, 0.93) (P respiratory disease, 0.89 (0.81, 0.98) (P = 0.012) (563 events) for fractures, and 1.02 (0.99, 1.06) (P = 0.21) (3121 events) for incident total cancers. Plasma 25(OH)D concentrations predict subsequent lower 13-y total mortality and incident cardiovascular disease, respiratory disease, and fractures but not total incident cancers. For mortality, lowest risks were in subjects with concentrations >90 nmol/L, and there was no evidence of increased mortality at high concentrations, suggesting that a moderate increase in population mean concentrations may have potential health benefit, but 120 nmol/L.

  7. Comparative trends in incident fracture rates for all long-term care and community-dwelling seniors in Ontario, Canada, 2002-2012.

    Science.gov (United States)

    Papaioannou, A; Kennedy, C C; Ioannidis, G; Cameron, C; Croxford, R; Adachi, J D; Mursleen, S; Jaglal, S

    2016-03-01

    In this population-based study, we compared incident fracture rates in long-term care (LTC) versus community seniors between 2002 and 2012. Hip fracture rates declined more rapidly in LTC than in the community. An excess burden of fractures occurred in LTC for hip, pelvis, and humerus fractures in men and hip fractures only in women. This study compares trends in incident fracture rates between long-term care (LTC) and community-dwelling seniors ≥65 years, 2002-2012. This is a population-based cohort study using administrative data. Measurements were age/sex-adjusted incident fracture rates and rate ratios (RR) and annual percent change (APC). Over 11 years, hip fracture rates had a marked decline occurring more rapidly in LTC (APC, -3.49 (95% confidence interval (CI), -3.97, -3.01)) compared with the community (APC, -2.93 (95% CI, -3.28, -2.57); p community (RRs: women, 1.55 (95% CI, 1.45, 1.67); men, 2.18 (95% CI, 1.93, 2.47)). Higher rates of pelvis (RR, 1.48 (95% CI, 1.22, 1.80)) and humerus (RR, 1.40 (95% CI, 1.07, 1.84)) fractures were observed in LTC men, not women. In women, wrist (RR, 0.76 (95% CI, 0.71, 0.81)) and spine (RR, 0.52 (95% CI, 0.45, 0.61)) fracture rates were lower in LTC than the community; in men, spine (RR, 0.75 (95% CI, 0.57, 0.98) but not wrist fracture (RR, 0.91 (95% CI, 0.67, 1.23)) rates were significantly lower in LTC than the community. Previous studies in the community have shown declining hip fracture rates over time, also demonstrated in our study but at a more rapid rate in LTC. Rates of humerus and wrist fractures also declined. An excess burden of fractures in LTC occurred for hip fractures in women and for hip, pelvis, and humerus fractures in men.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-07-01

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

  9. Critical cleavage fracture stress characterization of A508 nuclear pressure vessel steels

    International Nuclear Information System (INIS)

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

    2014-01-01

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

  10. A study on the fractures of iodine induced stress corrosion cracking of new zirconium alloys

    International Nuclear Information System (INIS)

    Peng Qian; Zhao Wenjin; Li Weijun; Tang Zhenghua; Heng Xuemei

    2005-10-01

    The morphology and chemical compositions of I-SCC fractures of new zirconium alloys were investigated by SEM and EDXA. The feature on fracture surface for I-SCC samples, such as corrosion products, the secondary cracking, intergranular cracking and pseudo-cleavage transgranular cracking, have been observed. And the fluting, the typical characteristic of I-SCC also has been found. Intergranular cracking is visible at crack initiation stage and transgranular cracking is distinguished at crack propagation stage. The corrosion products are mainly composed of Zr and O; and I can be detected on the local pseudocleavage zone. The most of grooves on the fractures of relieved-stress annealing samples are parallel with the roll plane. The intergranular cracking in relieved-stress annealing samples is not obvious. When the test temperature increases, the activity of iodine increases and the stress on crack tip is easier to be released, thus the corrosion products on fracture also increase and intergranular cracking is visible. The partial pressure of iodine influents the thickness of corrosion products, and intergranular cracking is easier to be found when iodine partial pressure is high enough. (authors)

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

    Science.gov (United States)

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

    2015-01-01

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

  12. The Incidence of Atypical Femoral Fractures in Patients with Rheumatic Disease: Yamagata Prefectural Committee of Atypical Femoral Fractures (YamaCAFe) Study.

    Science.gov (United States)

    Takakubo, Yuya; Ohta, Daichi; Ishi, Masaji; Ito, Juji; Oki, Hiroharu; Naganuma, Yasushi; Uno, Tomohiro; Sasaki, Akiko; Akabane, Takeru; Dairaku, Katsuyuki; Goto, Shinichi; Goto, Yasuo; Kanauchi, Yumiko; Kobayashi, Shinji; Nakajima, Taku; Masuda, Keiji; Matsuda, Michiharu; Mura, Nariyuki; Takenouchi, Kenji; Tsuchida, Hiroyuki; Onuma, Yasushi; Shibuya, Junichirou; Seino, Mitsuyoshi; Yamaguchi, Osamu; Hiragami, Ken; Urayama, Yasuhiro; Furukawa, Takashi; Okuda, Shouta; Ogura, Ken; Nakamura, Takeshi; Sasaki, Kan; Konta, Tsuneo; Takagi, Michiaki

    2017-08-01

    Atypical femoral fractures (AFFs) have been reported to occur with minimal or spontaneous subtrochanteric and femoral shaft fractures with a characteristic transverse pattern, compared with typical femoral fractures in young patients with high-energy trauma. AFFs are related to long-term use of bisphosphonates (BPs), glucocorticoids and rheumatic diseases. We have estimated a blind analysis of AFFs in rheumatic patients receiving BPs and glucocorticoids ordinary over a long time in all Yamagata prefectural area through radiographic examination. The 123 AFFs including suspected cases over six years were collected and reviewed by two independent orthopedic surgeons. We found 86 patients with a total of 99 AFFs between 2009 and 2014 (1.43 cases/100,000 person/year). Of these 99 AFFs, 11 were in 8 rheumatic patients including three patients with bilateral AFFs. The incidence of AFFs in rheumatic patients had trend to increase from 2012. The mean age of all 8 patients was 54.9 years. All 8 patients received BPs and 7/8 received prednisolone (PSL). The mean dose of PSL was 14 mg/day. Compared to patients with unilateral AFFs, those with bilateral AFFs in rheumatic patients were on a higher dose of PSL (20 mg/day vs. 7 mg/day) and had less femoral neck-shaft angle (129° vs. 136°, p rheumatic patients showed a trend to increase from 2012 to 2014 in Yamagata prefecture. Careful management of AFFs is of particular importance in rheumatic patients who have taken high doses of PSL and have small femoral neck-shaft angle.

  13. Double Threaded Screw Fixation for Bilateral Stress Fracture of the Medial Malleolus

    Directory of Open Access Journals (Sweden)

    Ryo Kanto

    2014-01-01

    Full Text Available An 18-year-old college basketball player presented with continued ankle pain. A radiographic examination showed bilateral medial malleolus stress fractures. Considering the prolonged history and refractory nature of this injury, surgery was adopted as a treatment option. At surgery, the fracture site was percutaneously fixed using two cannulated double threaded screws. Surgery for each side was sequentially performed two months apart. Prompt bony healing was attained after surgery, and the patient could return to his previous sports level six months after the first surgery without subsequent recurrence.

  14. [Incidence of hip fractures due to osteoporosis in relation to the prescription of drugs for their prevention and treatment in Galicia, Spain].

    Science.gov (United States)

    Guerra-García, María Mercedes; Rodríguez-Fernández, José Benito; Puga-Sarmiento, Elías; Charle-Crespo, María Ángeles; Gomes-Carvalho, Claudia Sofía; Prejigueiro-Santás, Ana

    2011-02-01

    To analyse the evolution in the incidence of hip fractures in our autonomous community in relationship to the trend in the prescription of medicines for the prevention and/or treatment of osteoporotic hip fracture. Descriptive observational ecological study. Public health network in the whole autonomous community over five years, from 1st January 2004 to 31st December 2008. Patients over 44 years old admitted with osteoporotic hip fracture. Medicines dispensed at a pharmacy which are indicated for the prevention of osteoporotic hip fractures (alendronate, risedronate and strontium ranelate). Exclusion: Open fractures, hospital or private or prescriptions. Incidence (number of new cases of hip fractures occurring in a year), Incidence rate (incidence per 100,000 inhabitants), Dispersion rate (number of packets dispensed per year per 100,000 inhabitants) and Hazard ratio (HR, ratio between the rate of last year and first). Annual rates were calculated standardised by the direct method. We identified 12,137 hospital admissions for fractured hip (2,792 men and 9,345 women). Sub-capital fractures: Mean Incidence Rate (MIR)=86.14,95%CI[61.85-110.42]; HR=1.22, 95%CI[0.82-1.63] (men) and MIR=180.88,95%CI[124.74-237.02]; HR=1.08,95%CI[0.73-1.43] (women). Trochanteric fractures: MIR=56.30,95%CI[39.18-73.42], HR=1.04,95%CI[0.75-1.34] (men) and MIR=136.51,95%CI[90.23-182.78]; HR=1.12,95%CI[0.89-1.35] (women). Subtrochanteric fractures: MIR=8.92,95%CI[6.52-11.32]; HR=1.26,95%CI[0.05-2.46] (men) and MIR=22.91,95%CI[15.24-30.58]; HR=1.08,95%CI[0.57-1.58] (women). Total HR fractures=1.07, 95%CI[0.92-1.23] (men) and 0.99,95%CI[0.83-1.17] (women). Drug dispensing (2008-2004): HR alendronate=1.30; HR risedronate=1.92; HR strontium ranelate=10.38. Over five years the dispensing of drugs by the public health service has multiplied for the prevention and treatment of hip fractures while the incidence has remained unaltered. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  15. The Relationship of Stressors and Stress on Injury Incident of Construction Workers in Penang

    Directory of Open Access Journals (Sweden)

    Muhd Ali Khairul Ammar

    2016-01-01

    Full Text Available Construction Workers (CWs are the main source of manpower that is necessary to every construction project. Non conducive and hazardous working environment at construction site will affect the physiological health of the construction labour. This study is conducted to explore the impact of job stress and emotional stress to the CWs that potentially lead to injuries incident in Penang. Twelve stressors were identified through factor analysis. Then, the stressors are classified into five main categories. Questionnaires were developed according to the stressstressor relationship. The correlation between factors of injury incident (stressor and stress shows that lack of autonomy and inappropriate safety equipment lead to the emotional stress among the CWs with 0.287 and 0.204 respectively. In addition, poor physical environment causes the job stress among CWs with the correlation of 0.270.

  16. Fractures and dislocations of the hand in polytrauma patients : Incidence, injury pattern and functional outcome

    NARCIS (Netherlands)

    Ferree, Steven; van der Vliet, Quirine M J; van Heijl, Mark; Houwert, Roderick M; Leenen, Luke P H; Hietbrink, Falco

    INTRODUCTION: Injuries of the hand can cause significant functional impairment, diminished quality of life and delayed return to work. However, the incidence and functional outcome of hand injuries in polytrauma patients is currently unknown. The aim of this study was to determine the incidence,

  17. Surgical stabilization of severe rib fractures decreases incidence of retained hemothorax and empyema.

    Science.gov (United States)

    Majercik, Sarah; Vijayakumar, Sathya; Olsen, Griffin; Wilson, Emily; Gardner, Scott; Granger, Steven R; Van Boerum, Don H; White, Thomas W

    2015-12-01

    Retained hemothorax (RH) is relatively common after chest trauma and can lead to empyema. We hypothesized that patients who have surgical fixation of rib fractures (SSRF) have less RH and empyema than those who have medical management of rib fractures (MMRF). Admitted rib fracture patients from January 2009 to June 2013 were identified. A 2:1 propensity score model identified MMRF patients who were similar to SSRF. RH, and empyema and readmissions, were recorded. Variables were compared using Fisher exact test and Wilcoxon rank-sum tests. One hundred thirty-seven SSRF and 274 MMRF were analyzed; 31 (7.5%) had RH requiring 35 interventions; 3 (2.2%) SSRF patients had RH compared with 28 (10.2%) MMRF (P = .003). Four (14.3%) MMRF subjects with RH developed empyema versus zero in the SSRF group (P = .008); 6 (19.3%) RH patients required readmission versus 14 (3.7%) in the non-RH group (P = .002). Patients with rib fractures who have SSRF have less RH compared with similar MMRF patients. Although not a singular reason to perform SSRF, this clinical benefit should not be overlooked. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Incidence of 'crown fracture' disease of oil palm in Ghana | Quaicoe ...

    African Journals Online (AJOL)

    An investigation into outbreak of a 'strange oil palm disease' at three locations in the Central and Western regions of Ghana showed the presence of 'crown fracture' disease in the country. Thirty-two cases of the disease were identified in Papagya (near Abakrampa), seven in Dwaboh (near Ayensudu), and six in the farm of ...

  19. Strontium Ranelate Reduces the Fracture Incidence in a Growing Mouse Model of Osteogenesis Imperfecta.

    Science.gov (United States)

    Shi, Changgui; Hu, Bo; Guo, Lei; Cao, Peng; Tian, Ye; Ma, Jun; Chen, Yuanyuan; Wu, Huiqiao; Hu, Jinquan; Deng, Lianfu; Zhang, Ying; Yuan, Wen

    2016-05-01

    Osteogenesis imperfecta (OI) is a genetic bone dysplasia characterized by brittle bones with increased fracture risk. Although current treatment options to improve bone strength in OI focus on antiresorptive bisphosphonates, controlled clinical trials suggest they have an equivocal effect on reducing fracture risk. Strontium ranelate (SrR) is a promising therapy with a dual mode of action that is capable of simultaneously maintaining bone formation and reducing bone resorption, and may be beneficial for the treatment of OI. In this study, SrR therapy was investigated to assess its effects on fracture frequency and bone mass and strength in an animal model of OI, the oim/oim mouse. Three-week-old oim/oim and wt/wt mice were treated with either SrR or vehicle (Veh) for 11 weeks. After treatment, the average number of fractures sustained by SrR-treated oim/oim mice was significantly reduced compared to Veh-treated oim/oim mice. Micro-computed tomographic (μCT) analyses of femurs showed that both trabecular and cortical bone mass were significantly improved with SrR treatment in both genotypes. SrR significantly inhibited bone resorption, whereas bone formation indices were maintained. Biomechanical testing revealed improved bone structural properties in both oim/oim and wild-type (wt/wt) mice under the treatment, whereas no significant effects on bone brittleness and material quality were observed. In conclusion, SrR was able to effectively reduce fractures in oim/oim mice by improving bone mass and strength and thus represents a potential therapy for the treatment of pediatric OI. © 2015 American Society for Bone and Mineral Research. © 2015 American Society for Bone and Mineral Research.

  20. A Comparison between Deep and Shallow Stress Fields in Korea Using Earthquake Focal Mechanism Inversions and Hydraulic Fracturing Stress Measurements

    Science.gov (United States)

    Lee, Rayeon; Chang, Chandong; Hong, Tae-kyung; Lee, Junhyung; Bae, Seong-Ho; Park, Eui-Seob; Park, Chan

    2016-04-01

    We are characterizing stress fields in Korea using two types of stress data: earthquake focal mechanism inversions (FMF) and hydraulic fracturing stress measurements (HF). The earthquake focal mechanism inversion data represent stress conditions at 2-20 km depths, whereas the hydraulic fracturing stress measurements, mostly conducted for geotechnical purposes, have been carried out at depths shallower than 1 km. We classified individual stress data based on the World Stress Map quality ranking scheme. A total of 20 FMF data were classified into A-B quality, possibly representing tectonic stress fields. A total of 83 HF data out of compiled 226 data were classified into B-C quality, which we use for shallow stress field characterization. The tectonic stress, revealed from the FMF data, is characterized by a remarkable consistency in its maximum stress (σ1) directions in and around Korea (N79±2° E), indicating a quite uniform deep stress field throughout. On the other hand, the shallow stress field, represented by HF data, exhibits local variations in σ1 directions, possibly due to effects of topography and geologic structures such as faults. Nonetheless, there is a general similarity in σ1 directions between deep and shallow stress fields. To investigate the shallow stress field statistically, we follow 'the mean orientation and wavelength analysis' suggested by Reiter et al. (2014). After the stress pattern analysis, the resulting stress points distribute sporadically over the country, not covering the entire region evenly. In the western part of Korea, the shallow σ1directions are generally uniform with their search radius reaching 100 km, where the average stress direction agrees well with those of the deep tectonic stress. We note two noticeable differences between shallow and deep stresses in the eastern part of Korea. First, the shallow σ1 orientations are markedly non-uniform in the southeastern part of Korea with their search radius less than 25 km

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

    Science.gov (United States)

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

    2018-01-01

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

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

    Science.gov (United States)

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

    2018-01-01

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

  3. Incidence and clinical relevance of tibiofibular synostosis in fractures of the ankle which have been treated surgically.

    Science.gov (United States)

    Droog, R; Verhage, S M; Hoogendoorn, J M

    2015-07-01

    In this retrospective cohort study, we analysed the incidence and functional outcome of a distal tibiofibular synostosis. Patients with an isolated AO type 44-B or C fracture of the ankle who underwent surgical treatment between 1995 and 2007 were invited for clinical and radiological review. The American Orthopaedic Foot and Ankle Society score, the American Academy of Orthopaedic Surgeons score and a visual analogue score for pain were used to assess outcome. A total of 274 patients were available; the mean follow-up was 9.7 years (8 to 18). The extent of any calcification or synostosis at the level of the distal interosseous membrane or syndesmosis on the contemporary radiographs was defined as: no or minor calcifications (group 1), severe calcification (group 2), or complete synostosis (group 3). A total of 222 (81%) patients were in group 1, 37 (14%) in group 2 and 15 (5%) in group 3. There was no significant difference in incidence between AO type 44-B and type 44-C fractures (p = 0.89). Severe calcification or synostosis occurred in 21 patients (19%) in whom a syndesmotic screw was used and in 31 (19%) in whom a syndesmotic screw was not used.(p = 0.70). No significant differences were found between the groups except for a greater reduction in mean dorsiflexion in group 2 (p = 0.004). This is the largest study on distal tibiofibular synostosis, and we found that a synostosis is a frequent complication of surgery for a fracture of the ankle. Although it theoretically impairs the range of movement of the ankle, it did not affect the outcome. Our findings suggest that synostosis of the distal tibiofibular syndesmosis in general does not warrant treatment. ©2015 The British Editorial Society of Bone & Joint Surgery.

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

    Directory of Open Access Journals (Sweden)

    Zhiyong Wang

    2014-01-01

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

  5. Incidence of osteonecrosis of the jaw in women with postmenopausal osteoporosis in the health outcomes and reduced incidence with zoledronic acid once yearly pivotal fracture trial.

    Science.gov (United States)

    Grbic, John T; Landesberg, Regina; Lin, Shou-Qing; Mesenbrink, Peter; Reid, Ian R; Leung, Ping-Chung; Casas, Noemi; Recknor, Christopher P; Hua, Ye; Delmas, Pierre D; Eriksen, Erik F

    2008-01-01

    The authors determined incidence of osteonecrosis of the jaw (ONJ) in a large, prospective three-year clinical trial of zoledronic acid in women with postmenopausal osteoporosis (PMO). A total of 7,714 women with PMO received intravenous zoledronic acid 5 mg or a placebo. No spontaneous reports of ONJ were received. An independent, blinded adjudication committee searched the trial's adverse event database by using 60 terms. On an ongoing basis, the committee reviewed the identified events, and it defined ONJ as exposed bone in the maxillofacial area with delayed healing for more than six weeks despite appropriate care. One participant who received a placebo and one participant who received zoledronic acid experienced delayed healing associated with infection. Both conditions resolved after antibiotic therapy, débridement or both. The occurrence of ONJ is rare in a PMO population, and delayed healing of lesions can occur with and without bisphosphonate use over three years. The low incidence of ONJ must be assessed in the context of the clinical benefit of zoledronic acid therapy in reducing hip, vertebral and nonvertebral fractures in this at-risk population. There is no evidence to suggest that healthy patients with osteoporosis who are receiving bisphosphonates require any special treatment beyond routine dental care or to support altering standard treatment practices.

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

    Directory of Open Access Journals (Sweden)

    Jessica M. Kohring

    2016-01-01

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

  7. Microstructural sensitivity of 316H austenitic stainless steel: Residual stress relaxation and grain boundary fracture

    Energy Technology Data Exchange (ETDEWEB)

    Chen, B., E-mail: b.chen@bristol.ac.uk [Department of Mechanical Engineering, University of Bristol, Bristol BS8 1TR (United Kingdom); Flewitt, P.E.J. [Interface Analysis Centre, University of Bristol, 121 St Michael' s Hill, Bristol BS2 8BS (United Kingdom); H.H. Wills Physics Laboratory, School of Physics, University of Bristol, Tyndall Avenue, Bristol BS8 1TL (United Kingdom); Smith, D.J. [Department of Mechanical Engineering, University of Bristol, Bristol BS8 1TR (United Kingdom)

    2010-10-25

    Research highlights: {yields} Triaxial residual macro-stresses have been measured by neutron diffraction. {yields} Rates of stress relaxation are shown to be a function of the microstructure. {yields} Quantification of M{sub 23}C{sub 6} precipitation was undertaken by a novel approach. {yields} Intergranular M{sub 23}C{sub 6} precipitation promotes the potential to intergranular fracture. {yields} Phosphorous segregation further enhances the potential to intergranular fracture. - Abstract: The present work considers the role of thermo-mechanical history on the generation and relaxation of residual stresses, typical of those encountered in Type 316H austenitic stainless steel thick section weldments. A series of thermo-mechanical pre-treatments have been developed and applied to simulate the critical microstructures observed within the heat affected zone of the thick section parent material. The through thickness distributions of the residual macro-stresses in cylindrical specimens have been measured by neutron diffraction and then the rates of the relaxation are shown to be a function of microstructure. The susceptibility to intergranular brittle fracture at a temperature of -196 deg. C is shown to be a function of M{sub 23}C{sub 6} carbide precipitates and phosphorous segregation at the grain boundaries. Finally, the link of the present study to the understanding of the reheat cracking is briefly discussed.

  8. Plate Versus Intramedullary Nail Fixation of Anterior Tibial Stress Fractures: A Biomechanical Study.

    Science.gov (United States)

    Markolf, Keith L; Cheung, Edward; Joshi, Nirav B; Boguszewski, Daniel V; Petrigliano, Frank A; McAllister, David R

    2016-06-01

    Anterior midtibial stress fractures are an important clinical problem for patients engaged in high-intensity military activities or athletic training activities. When nonoperative treatment has failed, intramedullary (IM) nail and plate fixation are 2 surgical options used to arrest the progression of a fatigue fracture and allow bone healing. A plate will be more effective than an IM nail in preventing the opening of a simulated anterior midtibial stress fracture from tibial bending. Controlled laboratory study. Fresh-frozen human tibias were loaded by applying a pure bending moment in the sagittal plane. Thin transverse saw cuts, 50% and 75% of the depth of the anterior tibial cortex, were created at the midtibia to simulate a fatigue fracture. An extensometer spanning the defect was used to measure the fracture opening displacement (FOD) before and after the application of IM nail and plate fixation constructs. IM nails were tested without locking screws, with a proximal screw only, and with proximal and distal screws. Plates were tested with unlocked bicortical screws (standard compression plate) and locked bicortical screws; both plate constructs were tested with the plate edge placed 1 mm from the anterior tibial crest (anterior location) and 5 mm posterior to the crest. For the 75% saw cut depth, the mean FOD values for all IM nail constructs were 13% to 17% less than those for the saw cut alone; the use of locking screws had no significant effect on the FOD. The mean FOD values for all plate constructs were significantly less than those for all IM nail constructs. The mean FOD values for all plates were 28% to 46% less than those for the saw cut alone. Anterior plate placement significantly decreased mean FOD values for both compression and locked plate constructs, but the mean percentage reductions for locked and unlocked plates were not significantly different from each other for either plate placement. The percentage FOD reductions for all plate

  9. Revisiting fracture gradient: Comments on “A new approaching method to estimate fracture gradient by correcting Matthew–Kelly and Eaton's stress ratio”

    KAUST Repository

    Hakiki, Farizal

    2017-07-25

    A study performed by Marbun et al. [1] claimed that “A new methodology to predict fracture pressure from former calculations, Matthew–Kelly and Eaton are proposed.” Also, Marbun et al.\\'s paper stated that “A new value of Poisson\\'s and a stress ratio of the formation were generated and the accuracy of fracture gradient was improved.” We found those all statements are incorrect and some misleading concepts are revealed. An attempt to expose the method of fracture gradient determination from industry practice also appears to solidify that our arguments are acceptable to against improper Marbun et al.\\'s claims.

  10. Polymorphisms of muscle genes are associated with bone mass and incident osteoporotic fractures in Caucasians

    DEFF Research Database (Denmark)

    Harsløf, Torben; Frost, M; Nielsen, T L

    2013-01-01

    The interaction between muscle and bone is complex. The aim of this study was to investigate if variations in the muscle genes myostatin (MSTN), its receptor (ACVR2B), myogenin (MYOG), and myoD1 (MYOD1) were associated with fracture risk, bone mineral density (BMD), bone mineral content (BMC......), and lean body mass. We analyzed two independent cohorts: the Danish Osteoporosis Prevention Study (DOPS), comprising 2,016 perimenopausal women treated with hormone therapy or not and followed for 10 years, and the Odense Androgen Study (OAS), a cross-sectional, population-based study on 783 men aged 20......-29 years. Nine tag SNPs in the four genes were investigated. In the DOPS, individuals homozygous for the variant allele of the MSTN SNP rs7570532 had an increased risk of any osteoporotic fracture, with an HR of 1.82 (95 % CI 1.15-2.90, p = 0.01), and of nonvertebral osteoporotic fracture, with an HR of 2...

  11. Preventing construction worker injury incidents through the management of personal stress and organizational stressors.

    Science.gov (United States)

    Leung, Mei-yung; Chan, Isabelle Yee Shan; Yu, Jingyu

    2012-09-01

    Construction workers (CWs) are positioned at the lowest level of an organization and thus have limited control over their work. For this reason, they are often deprived of their due rewards and training or sometimes are even compelled to focus on production at the expense of their own safety. These organizational stressors not only cause the CWs stress but also impair their safety behaviors. The impairment of safety behaviors is the major cause of CW injury incidents. Hence, to prevent injury incidents and enhance safety behaviors of CWs, the current study aimed to identify the impact of various organizational stressors and stress on CW safety behaviors and injury incidents. To achieve this aim, we surveyed 395 CWs. Using factor analysis, we identified five organizational stressors (unfair reward and treatment, inappropriate safety equipment, provision of training, lack of goal setting, and poor physical environment), two types of stress (emotional and physical), and safety behaviors. The results of correlation and regression analyses revealed the following: (1) injury incidents were minimized by safety behaviors but escalated by a lack of goal setting, (2) safety behaviors were maximized by moderate levels of emotional stress (i.e., an inverted U-shape relationship between these two variables) and increased in line with physical stress and inappropriate safety equipment, (3) emotional stress was positively predicted by the provision of training and inappropriate safety equipment, and (4) physical stress was predicted only by inappropriate safety equipment. Based on these results, we suggest various recommendations to construction stakeholders on how to prevent CW injury incidents. Copyright © 2011 Elsevier Ltd. All rights reserved.

  12. CHARACTERIZATION OF IN-SITU STRESS AND PERMEABILITY IN FRACTURED RESERVOIRS

    Energy Technology Data Exchange (ETDEWEB)

    Daniel R. Burns; M. Nafi Toksoz

    2002-12-31

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

  13. Negative magnetic resonance imaging in three cases of anterior tibial cortex stress fractures

    International Nuclear Information System (INIS)

    Smith, Ralph; Moghal, M.; Newton, J.L.; Jones, N.; Teh, J.

    2017-01-01

    Anterior mid-tibial cortex stress fractures (ATCSF) are uncommon and notoriously challenging to treat. They are termed high risk due to their predilection to prolonged recovery, nonunion and complete fracture. Early diagnosis is essential to avoid progression and reduce fracture complications. Imaging plays a key role in confirming the diagnosis. Magnetic resonance imaging (MRI) is accepted as the gold standard modality due to its high accuracy and nonionizing properties. This report describes three cases of ATCSFs in recreational athletes who had positive radiographic findings with no significant MRI changes. Two athletes had multiple striations within their tibias. Despite the radiographic findings, their severity of symptoms were low with mild or no tenderness on examination. Clinicians should be mindful that the ATCSFs may not present with typical acute stress fracture symptoms. We recommend that plain radiographs should be used as the first line investigation when suspecting ATCSFs. Clinicians should be aware that despite MRI being considered the gold standard imaging modality, we report three cases where the MRI was unremarkable, whilst radiographs and computed tomography confirmed the diagnosis. We urge clinicians to continue to use radiographs as the first line imaging modality for ATCSFs and not to directly rely on MRI. Those who opt directly for MRI may be falsely reassured causing a delay in diagnosis. (orig.)

  14. Negative magnetic resonance imaging in three cases of anterior tibial cortex stress fractures

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Ralph; Moghal, M.; Newton, J.L.; Jones, N. [Oxford University Hospitals NHS Foundation Trust, Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford (United Kingdom); Teh, J. [Oxford University Hospitals NHS Foundation Trust, Department of Radiology, Nuffield Orthopaedic Centre Oxford, Oxford (United Kingdom)

    2017-12-15

    Anterior mid-tibial cortex stress fractures (ATCSF) are uncommon and notoriously challenging to treat. They are termed high risk due to their predilection to prolonged recovery, nonunion and complete fracture. Early diagnosis is essential to avoid progression and reduce fracture complications. Imaging plays a key role in confirming the diagnosis. Magnetic resonance imaging (MRI) is accepted as the gold standard modality due to its high accuracy and nonionizing properties. This report describes three cases of ATCSFs in recreational athletes who had positive radiographic findings with no significant MRI changes. Two athletes had multiple striations within their tibias. Despite the radiographic findings, their severity of symptoms were low with mild or no tenderness on examination. Clinicians should be mindful that the ATCSFs may not present with typical acute stress fracture symptoms. We recommend that plain radiographs should be used as the first line investigation when suspecting ATCSFs. Clinicians should be aware that despite MRI being considered the gold standard imaging modality, we report three cases where the MRI was unremarkable, whilst radiographs and computed tomography confirmed the diagnosis. We urge clinicians to continue to use radiographs as the first line imaging modality for ATCSFs and not to directly rely on MRI. Those who opt directly for MRI may be falsely reassured causing a delay in diagnosis. (orig.)

  15. Incidence of depression, anxiety and stress following traumatic injury: a longitudinal study.

    Science.gov (United States)

    Wiseman, Taneal A; Curtis, Kate; Lam, Mary; Foster, Kim

    2015-03-28

    Traumatic injury and mental health disorders are co-associated. Early identification of depression, anxiety and stress following injury, and subsequent preventive intervention, may reduce the long-term symptoms and negative impacts associated with depression and anxiety. The purpose of the study was to determine the incidence, severity and predictors of depression, anxiety and stress in injured patients in the acute phase of care, and at six months following injury, as well as the effectiveness of an in-hospital screening tool. This descriptive longitudinal study of trauma patients was conducted at a Level 1 Metropolitan Trauma Centre in Australia over 14 months. Participants were interviewed using the Depression Anxiety Stress Scale short-form version (DASS-21) during hospital admission then at 3 and 6 months after injury. Descriptive statistics were performed to evaluate participant characteristics and incidence of depression, anxiety and stress. Correlations and logistic regression were conducted to investigate the ability of the DASS-21 to predict symptoms of depression, anxiety and stress and to investigate factors associated with depression, anxiety and stress 6 months after injury. 201 participants ranging in age (18-94 years) and injury severity participated in the baseline interview and 109 completed all 3 interviews over 6 months. Over half (54%) reported above normal scores for depression, anxiety and/or stress in at least one of the 3 time points. Intensive care unit admission and high levels of depression, anxiety and stress at 3 months post injury were predictors for high levels of depression, anxiety and stress at 6 months. Low scores for depression, anxiety and stress during admission were correlated with low scores for depression, anxiety and stress at 3 and 6 months. Depression, anxiety and stress in patients hospitalised following injury is common and should be anticipated in patients who have had an intensive care admission. Screening at 3

  16. Description of the incidence, clinical presentation and outcome of proximal limb and pelvic fractures in Hong Kong racehorses during 2003-2014.

    Science.gov (United States)

    McGlinchey, L; Hurley, M J; Riggs, C M; Rosanowski, S M

    2017-11-01

    Few studies have described incidences of proximal limb and pelvic fracture (PLPF) in Thoroughbred racehorses occurring on race day and during training. Information regarding clinical presentations and future racing careers in cases of PLPF is limited. To describe the incidence, clinical presentation and outcome of PLPF sustained by horses in racing and training at the Hong Kong Jockey Club (HKJC) between 2003 and 2014. Retrospective cohort study. Horses with PLPF confirmed by nuclear scintigraphy, ultrasonography, radiography or post-mortem examination were identified using veterinary clinical records. Training and racing data for case horses were described. Incidences of fractures were estimated per 1000 horses in training and per 1000 race starts for fractures sustained during racing. Descriptive statistics were used to describe the study population. A total of 129 instances of PLPF were sustained by 108 racehorses. The most commonly fractured bone was the humerus (49.6%), followed by the tibia (29.4%). Nine horses sustained fatal fractures, eight of which occurred during racing. The incidence of fracture during racing was 0.30 per 1000 starts. Two-thirds of fractures occurred during training. The majority of horses presented with grade 3 lameness (n = 42 of 119 injury events, 35.3%). All horses presenting with grade 5 lameness sustained fatal injuries. Following noncatastrophic injury, all horses underwent box rest and 81 horses subsequently resumed racing; 45 of these won a race. Horses were retired at a median of 25 months (interquartile range: 15-36 months) after injury. Protocols for resting non-training racehorses at the HKJC and for recording rehabilitation regimens post-injury prevented the calculation of horse days at risk. The incidence of PLPF at the HKJC is low. Non-fatal PLPF is not necessarily a career-ending injury and many horses resume racing successfully following conservative treatment. © 2017 EVJ Ltd.

  17. Incidence of depression, anxiety and stress following traumatic injury: a longitudinal study

    OpenAIRE

    Wiseman, Taneal A; Curtis, Kate; Lam, Mary; Foster, Kim

    2015-01-01

    Background Traumatic injury and mental health disorders are co-associated. Early identification of depression, anxiety and stress following injury, and subsequent preventive intervention, may reduce the long-term symptoms and negative impacts associated with depression and anxiety. The purpose of the study was to determine the incidence, severity and predictors of depression, anxiety and stress in injured patients in the acute phase of care, and at six months following injury, as well as the ...

  18. Mindfulness-based stress reduction teachers, practice characteristics, cancer incidence, and health: a nationwide ecological description.

    Science.gov (United States)

    Robb, Sara Wagner; Benson, Kelsey; Middleton, Lauren; Meyers, Christine; Hébert, James R

    2015-02-14

    Studies have demonstrated the potential of the Mindfulness-Based Stress Reduction (MBSR) program to improve the condition of individuals with health outcomes such as hypertension, diabetes, and chronic pain; improve psychological well-being; reduce stress levels; and increase survival among cancer patients. To date, only one study has focused on the effect of long-term meditation on stress, showing a positive protective relationship. However, the relationship between meditation and cancer incidence remains unexplored. The objective of this study was to describe the state-level relationship between MBSR instructors and their practices and county-level health outcomes, including cancer incidence, in the United States. This ecologic study was performed using geospatial mapping and descriptive epidemiology of statewide MBSR characteristics and overall health, mental health state rankings, and age-adjusted cancer incidence rates. Weak to moderate state-level correlations between meditation characteristics and colorectal and cervical cancer incidence were detected, with states with more meditation (e.g., more MBSR teachers per population) correlated with a decreased cancer incidence. A negative correlation was detected between lung & bronchus cancer and years teaching MBSR only. Moderate positive correlations were detected between Hodgkin's Lymphoma and female breast cancer in relation to all meditation characteristics. Statistically significant correlations with moderate coefficients were detected for overall health ranks and all meditation characteristics, most strongly for total number of years teaching MBSR and total number of years of general meditation practice. Our analyses might suggest that a relationship exists between the total number of MBSR teachers per state and the total number of years of general meditation practice per state, and colorectal and cervical cancer incidence. Positive correlations were observed with overall health rankings. Despite this study

  19. Bone strength estimates relative to vertical ground reaction force discriminates women runners with stress fracture history.

    Science.gov (United States)

    Popp, Kristin L; McDermott, William; Hughes, Julie M; Baxter, Stephanie A; Stovitz, Steven D; Petit, Moira A

    2017-01-01

    To determine differences in bone geometry, estimates of bone strength, muscle size and bone strength relative to load, in women runners with and without a history of stress fracture. We recruited 32 competitive distance runners aged 18-35, with (SFX, n=16) or without (NSFX, n=16) a history of stress fracture for this case-control study. Peripheral quantitative computed tomography (pQCT) was used to assess volumetric bone mineral density (vBMD, mg/mm 3 ), total (ToA) and cortical (CtA) bone areas (mm 2 ), and estimated compressive bone strength (bone strength index; BSI, mg/mm 4 ) at the distal tibia. ToA, CtA, cortical vBMD, and estimated strength (section modulus; Zp, mm 3 and strength strain index; SSIp, mm 3 ) were measured at six cortical sites along the tibia. Mean active peak vertical (pkZ) ground reaction forces (GRFs), assessed from a fatigue run on an instrumented treadmill, were used in conjunction with pQCT measurements to estimate bone strength relative to load (mm 2 /N∗kg -1 ) at all cortical sites. SSIp and Zp were 9-11% lower in the SFX group at mid-shaft of the tibia, while ToA and vBMD did not differ between groups at any measurement site. The SFX group had 11-17% lower bone strength relative to mean pkZ GRFs (phistory of stress fracture. Bone strength relative to load is also lower in this same region suggesting that strength deficits in the middle 1/3 of the tibia and altered gait biomechanics may predispose an individual to stress fracture. Copyright © 2016. Published by Elsevier Inc.

  20. Ground reaction forces and bone parameters in females with tibial stress fracture.

    Science.gov (United States)

    Bennell, Kim; Crossley, Kay; Jayarajan, Jyotsna; Walton, Elizabeth; Warden, Stuart; Kiss, Z Stephen; Wrigley, Tim

    2004-03-01

    Tibial stress fracture is a common overuse running injury that results from the interplay of repetitive mechanical loading and bone strength. This research project aimed to determine whether female runners with a history of tibial stress fracture (TSF) differ in ground reaction force (GRF) parameters during running, regional bone density, and tibial bone geometry from those who have never sustained a stress fracture (NSF). Thirty-six female running athletes (13 TSF; 23 NSF) ranging in age from 18 to 44 yr were recruited for this cross-sectional study. The groups were well matched for demographic, training, and menstrual parameters. A force platform measured selected GRF parameters (peak and time to peak for vertical impact and active forces, and horizontal braking and propulsive forces) during overground running at 4.0 m.s.(-1). Lumbar spine, proximal femur, and distal tibial bone mineral density were assessed by dual energy x-ray absorptiometry. Tibial bone geometry (cross-sectional dimensions and areas, and second moments of area) was calculated from a computerized tomography scan at the junction of the middle and distal thirds. There were no significant differences between the groups for any of the GRF, bone density, or tibial bone geometric parameters (P > 0.05). Both TSF and NSF subjects had bone density levels that were average or above average compared with a young adult reference range. Factor analysis followed by discriminant function analysis did not find any combinations of variables that differentiated between TSF and NSF groups. These findings do not support a role for GRF, bone density, or tibial bone geometry in the development of tibial stress fractures, suggesting that other risk factors were more important in this cohort of female runners.

  1. Risk Stratification of Stress Fractures and Prediction of Return-to-Duty

    Science.gov (United States)

    2016-12-01

    mgh.harvard.edu; mbouxsei@bidmc.harvard.edu 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Massachusetts General Hospital AND...ADDRESS(ES) 8. PERFORMING ORGANIZATION REPORT NUMBER Boston, MA 02114-2554 9. SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR...with recent stress fracture enrolled. 15. SUBJECT TERMS bone microarchitecture, HRpQCT, race, gender , sex, bone mineral density, vBMD, bone geometry

  2. Evidence of Deep Water Penetration in Silica during Stress Corrosion Fracture

    OpenAIRE

    Lechenault, F.; Rountree, C. L.; Cousin, F.; Bouchaud, J.-P.; Ponson, L.; Bouchaud, E.

    2011-01-01

    We measure the thickness of the heavy water layer trapped under the stress corrosion fracture surface of silica using neutron reflectivity experiments. We show that the penetration depth is 65-85 \\aa ngstr\\"{o}ms, suggesting the presence of a damaged zone of $\\approx$ 100 \\aa ngstr\\"{o}ms extending ahead of the crack tip during its propagation. This estimate of the size of the damaged zone is compatible with other recent results.

  3. Stress fracture of the second metacarpal bone in a badminton player.

    Science.gov (United States)

    Fukuda, Koji; Fujioka, Hiroyuki; Fujita, Ikuo; Uemoto, Harunobu; Hiranaka, Takafumi; Tsuji, Mitsuo; Kurosaka, Masahiro

    2008-07-18

    We present a rare case of stress fracture of the second metacarpal bone. A 14-year-old girl felt pain on the dorsal aspect of the right wrist without any history of major trauma, when she played a smash during a game of badminton. On the radiographs, periosteal reaction was detected on the ulnar aspect of the base of the second metacarpal bone. She was treated conservatively and she returned to the original activity level.

  4. Stress fracture of the proximal humeral epiphysis in an elite junior badminton player.

    Science.gov (United States)

    Boyd, K T; Batt, M E

    1997-01-01

    An elite junior badminton player presented with a chronic painful dominant shoulder after an intense training course. An acute stress fracture to the proximal humeral epiphysis was found. Two-plane radiography will identify abnormalities of the growth plate but comparative films of the unaffected side may also be required to differentiate subtle changes. Rest with subsequent rehabilitation is the appropriate management of these injuries although ideally they should be subjected to primary prevention. Images Figure 1 Figure 2 PMID:9298564

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

    Science.gov (United States)

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

    2016-03-01

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

  6. A stress-based fracture criteria validated on mixed microstructures of ferrite and bainite over a range of stress triaxialities

    Energy Technology Data Exchange (ETDEWEB)

    Golling, Stefan, E-mail: stefan.golling@ltu.se [Luleå University of Technology, SE 971 87 Luleå (Sweden); Östlund, Rickad [Gestamp HardTech, Ektjärnsvägen 5, SE 973 45 Luleå (Sweden); Oldenburg, Mats [Luleå University of Technology, SE 971 87 Luleå (Sweden)

    2016-09-30

    Hot stamping is a sequential process for formation and heat-treatment of sheet metal components with superior mechanical properties. By applying different cooling rates, the microstructural composition and thus the material properties of steel can be designed. By controlling the cooling rate in different sections of a blank, the material properties can be tailored depending on the desired toughness. Under continuous cooling, various volume fractions of ferrite and bainite are formed depending on the rate of cooling. This paper focuses on the ductile fracture behavior of a thin sheet metal made of low-alloyed boron steel with varying amounts of ferrite and bainite. An experimental setup was applied in order to produce microstructures with different volume fractions of ferrite and bainite. In total, five different test specimen geometries, representing different stress triaxialities, were heat treated and tensile tested. Through full-field measurements, flow curves extending beyond necking and the equivalent plastic strain to fracture were determined. Experimental results were further investigated using a mean-field homogenization scheme combined with local fracture criteria. The mean-field homogenization scheme comprises the influence of microstructure composition and stress triaxiality with usable accuracy, connoting auspicious possibilities for constitutive modeling of hot-stamped components.

  7. EAP-based critical incident stress management: utilization of a practice-based assessment of incident severity level in responding to workplace trauma.

    Science.gov (United States)

    DeFraia, Gary S

    2013-01-01

    Central to the field of trauma psychology is assessment of the impact of critical incidents on individuals, as measured by individual symptoms of stress. Accordingly, the trauma literature reflects a proliferation of clinical impact of event scales. Workplace incidents however, affect not only individual employees, but also work organizations, requiring a multi-level response. Critical incident stress management (CISM) is the most prevalent multi-level incident response strategy utilized by organizations, often through specialized CISM units operating within their employee assistance programs (EAPs). While EAP-based CISM units seeks to support both individuals and organizations, studies focused on individual stress dominate the literature, mirroring assessment scales that tend to emphasize clinical as opposed to organizational practice. This research contributes to less-prevalent studies exploring incident characteristics as disruptive to organizations, rather than clinical symptoms as disruptive to individuals. To measure incident disruption, an EAP-based CISM unit developed a critical incident severity scale. By analyzing this unit's extensive practice database, this exploratory study examines how critical incident severity level varies among various types of incidents. Employing the methodology of clinical data mining, this practice-based research generates evidence-informed practice recommendations in the areas of EAP-based CISM intake assessment, organizational consultation and incident response planning.

  8. Stress fractures of the base of the metatarsal bones in young trainee ballet dancers

    Science.gov (United States)

    Albisetti, Walter; De Bartolomeo, Omar; Tagliabue, Lorenzo; Camerucci, Emanuela; Calori, Giorgio Maria

    2009-01-01

    Classical ballet is an art form requiring extraordinary physical activity, characterised by rigorous training. These can lead to many overuse injuries arising from repetitive minor trauma. The purpose of this paper is to report our experience in the diagnosis and treatment of stress fractures at the base of the second and third metatarsal bones in young ballet dancers. We considered 150 trainee ballet dancers from the Ballet Schools of "Teatro Alla Scala" of Milan from 2005 to 2007. Nineteen of them presented with stress fractures of the base of the metatarsal bones. We treated 18 dancers with external shockwave therapy (ESWT) and one with pulsed electromagnetic fields (EMF) and low-intensity ultrasound (US); all patients were recommended rest. In all cases good results were obtained. The best approach to metatarsal stress fractures is to diagnose them early through clinical examination and then through X-ray and MRI. ESWT gave good results, with a relatively short time of rest from the patients’ activities and a return to dancing without pain. PMID:19415273

  9. Screening and Predicting Posttraumatic Stress and Depression in Children Following Single-Incident Trauma

    Science.gov (United States)

    Nixon, Reginald D. V.; Ellis, Alicia A.; Nehmy, Thomas J.; Ball, Shelley-Anne

    2010-01-01

    Three screening methods to predict posttraumatic stress disorder (PTSD) and depression symptoms in children following single-incident trauma were tested. Children and adolescents (N = 90; aged 7-17 years) were assessed within 4 weeks of an injury that led to hospital treatment and followed up 3 and 6 months later. Screening methods were adapted…

  10. Incidence and Predictors of Multiple Fractures Despite High Adherence to Oral Bisphosphonates

    DEFF Research Database (Denmark)

    Hawley, Samuel; Javaid, M Kassim; Rubin, Katrine H

    2016-01-01

    , Spain) and Danish Health Registries (Denmark) for all incident users of oral BPs in 2006-2007 and 2000-2001 respectively. Fine and Gray survival models using backward-stepwise selection (p-entry 0.049; p-exit 0.10) and accounting for the competing risk of therapy cessation were used to identify...

  11. Intergranular fracture stress and phosphorus grain boundary segregation of a Mn-Ni-Mo steel

    International Nuclear Information System (INIS)

    Naudin, C.; Frund, J.M.; Pineau, A.

    1999-01-01

    Nuclear Reactor Pressure Vessel (RPV) steel A508 class 3 which is a low alloyed steel is not usually sensitive to reversible temper embrittlement when properly heat treated. However heterogeneous zones may be present in particular near the inner side of the vessel. These zones result from the segregation of the alloying elements (C, Mn, Ni, Mo) and impurities (S, P) taking place during solidification of the material. They are called segregated zones (or ghost lines). They can reach 2 mm thick along the radius and 30 mm long through the circumferential direction. Their susceptibility to reversible temper embrittlement is mainly due to grain boundary phosphorus segregation triggering brittle intergranular fracture when the material is tested at low temperature. In this material like in other steels the influence of some other alloying elements (Mo, Mn...) is clearly significant and should also be taken into account. But phosphorus effect has proved to be predominant. The aim of the present study is therefore to find out a quantitative relationship between grain boundary phosphorus segregation and critical intergranular fracture stress. A synthetic steel with a chemical composition representative of an average segregated zone was prepared for the present study. A number of heat treatments were applied to reach different embrittlement conditions. Then brittle fracture properties were obtained by performing cryogenic fracture tests on notched tensile specimens while the corresponding grain boundary phosphorus levels were measured by Auger electron spectroscopy. Systematic fractographic observations were carried out. Moreover an attempt to determine the influence of temperature on the critical intergranular fracture stress was made

  12. Critical Incident Stress Management (CISM) in complex systems: cultural adaptation and safety impacts in healthcare.

    Science.gov (United States)

    Müller-Leonhardt, Alice; Mitchell, Shannon G; Vogt, Joachim; Schürmann, Tim

    2014-07-01

    In complex systems, such as hospitals or air traffic control operations, critical incidents (CIs) are unavoidable. These incidents can not only become critical for victims but also for professionals working at the "sharp end" who may have to deal with critical incident stress (CIS) reactions that may be severe and impede emotional, physical, cognitive and social functioning. These CIS reactions may occur not only under exceptional conditions but also during every-day work and become an important safety issue. In contrast to air traffic management (ATM) operations in Europe, which have readily adopted critical incident stress management (CISM), most hospitals have not yet implemented comprehensive peer support programs. This survey was conducted in 2010 at the only European general hospital setting which implemented CISM program since 2004. The aim of the article is to describe possible contribution of CISM in hospital settings framed from the perspective of organizational safety and individual health for healthcare professionals. Findings affirm that daily work related incidents also can become critical for healthcare professionals. Program efficiency appears to be influenced by the professional culture, as well as organizational structure and policies. Overall, findings demonstrate that the adaptation of the CISM program in general hospitals takes time but, once established, it may serve as a mechanism for changing professional culture, thereby permitting the framing of even small incidents or near misses as an opportunity to provide valuable feedback to the system. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. The effect of army vest design on the occurrence of stress fractures and overuse injuries in female military recruits.

    Science.gov (United States)

    Palmanovich, Ezequiel; Frankl, M; Nyska, M; Hetsroni, I; Constantini, N; Trejo, L; Bechar, R; Novak, G; Lankovsky, Z; Mann, G

    2017-08-01

    Stress fractures (SFs) occur when microdamage caused by repetitive mechanical load exceeds the biological load-bearing capacity of the bone. The study objective was to test whether a vest specifically designed and manufactured for female recruits, compared with the standard vest used on a regular basis by Border Police recruits, would reduce the incidence of SF in female Border Police recruits. Data based on reports of military personnel show that women are more likely to sustain SFs. A follow-up of 240 female Border Police infantry recruits, divided into two trial groups, was conducted from 2007 to 2009. Two different vests were evaluated-the standard special unit fighting vest, which was conventionally used by both men and women during basic training, and the new fighting vest, specially design for female body shape. No significant difference was noted in the number of SFs between the two groups which may be attributed to increased weight of the new vest. There was a lower incidence of long bone SFs which may have been due to the superior vest design. The female Border Police Infantry recruits expressed great satisfaction with the new vest. Increased effort should be invested to further reduce the weight of female combat gear, alongside efforts to improve fit and comfort. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  14. Additional Stress And Fracture Mechanics Analyses Of Pressurized Water Reactor Pressure Vessel Nozzles

    International Nuclear Information System (INIS)

    Walter, Matthew; Yin, Shengjun; Stevens, Gary; Sommerville, Daniel; Palm, Nathan; Heinecke, Carol

    2012-01-01

    In past years, the authors have undertaken various studies of nozzles in both boiling water reactors (BWRs) and pressurized water reactors (PWRs) located in the reactor pressure vessel (RPV) adjacent to the core beltline region. Those studies described stress and fracture mechanics analyses performed to assess various RPV nozzle geometries, which were selected based on their proximity to the core beltline region, i.e., those nozzle configurations that are located close enough to the core region such that they may receive sufficient fluence prior to end-of-life (EOL) to require evaluation of embrittlement as part of the RPV analyses associated with pressure-temperature (P-T) limits. In this paper, additional stress and fracture analyses are summarized that were performed for additional PWR nozzles with the following objectives: To expand the population of PWR nozzle configurations evaluated, which was limited in the previous work to just two nozzles (one inlet and one outlet nozzle). To model and understand differences in stress results obtained for an internal pressure load case using a two-dimensional (2-D) axi-symmetric finite element model (FEM) vs. a three-dimensional (3-D) FEM for these PWR nozzles. In particular, the ovalization (stress concentration) effect of two intersecting cylinders, which is typical of RPV nozzle configurations, was investigated. To investigate the applicability of previously recommended linear elastic fracture mechanics (LEFM) hand solutions for calculating the Mode I stress intensity factor for a postulated nozzle corner crack for pressure loading for these PWR nozzles. These analyses were performed to further expand earlier work completed to support potential revision and refinement of Title 10 to the U.S. Code of Federal Regulations (CFR), Part 50, Appendix G, Fracture Toughness Requirements, and are intended to supplement similar evaluation of nozzles presented at the 2008, 2009, and 2011 Pressure Vessels and Piping (PVP

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

    Science.gov (United States)

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

    2017-03-01

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

  16. The Pennsylvania Experience with Hydraulic Fracturing for Shale Gas Development: Relatively Infrequent Water Quality Incidents with Lots of Public Attention

    Science.gov (United States)

    Brantley, S. L.; Li, Z.; Yoxtheimer, D.; Vidic, R.

    2015-12-01

    New techniques of hydraulic fracturing - "fracking" - have changed the United States over the last 10 years into a leading producer of natural gas extraction from shale. The first such gas well in Pennsylvania was drilled and completed using high-volume hydraulic fracturing in 2004. By late 2014, more than 8500 of these gas wells had been drilled in the Marcellus Shale gas field in Pennsylvania alone. Almost 1000 public complaints about groundwater quality were logged by the PA Department of Environmental Protection (PA DEP) between 2008 and 2012. Only a fraction of these were attributed to unconventional gas development. The most common problem was gas migration into drinking water, but contamination incidents also included spills, seepage, or leaks of fracking fluids, brine salts, or very occasionally, radioactive species. Many problems of gas migration were from a few counties in the northeastern part of the state. However, sometimes one gas well contaminated multiple water wells. For example, one gas well was reported by the state regulator to have contaminated 18 water wells with methane near Dimock PA. It can be argued that such problems at a relatively small fraction of gas wells initiated pockets of pushback against fracking worldwide. This resistance to fracking has grown even though fracking has been in use in the U.S.A. since the 1940s. We have worked as part of an NSF-funded project (the Shale Network) to share water quality data and publish it online using the CUAHSI Hydrologic Information System. Sharing data has led to collaborative investigation of specific contamination incidents to understand how problems can occur, and to efforts to quantify the frequency of impacts. The Shale Network efforts have also highlighted the need for more transparency with water quality data in the arena related to the energy-water nexus. As more data are released, new techniques of data analysis will allow better understanding of how to tune best practices to be

  17. Fracture mechanics and residual fatigue life analysis for complex stress fields. Technical report

    International Nuclear Information System (INIS)

    Besuner, P.M.

    1975-07-01

    This report reviews the development and application of an influence function method for calculating stress intensity factors and residual fatigue life for two- and three-dimensional structures with complex stress fields and geometries. Through elastic superposition, the method properly accounts for redistribution of stress as the crack grows through the structure. The analytical methods used and the computer programs necessary for computation and application of load independent influence functions are presented. A new exact solution is obtained for the buried elliptical crack, under an arbitrary Mode I stress field, for stress intensity factors at four positions around the crack front. The IF method is then applied to two fracture mechanics problems with complex stress fields and geometries. These problems are of current interest to the electric power generating industry and include (1) the fatigue analysis of a crack in a pipe weld under nominal and residual stresses and (2) fatigue analysis of a reactor pressure vessel nozzle corner crack under a complex bivariate stress field

  18. Residual stress effects on the K parameter of the fracture mechanics

    International Nuclear Information System (INIS)

    Soares, Maria da Conceiccao B. Vieira; Andrade, Arnaldo H. Paes de

    1996-01-01

    Compressive residual stresses are beneficial and improve resistance to fracture and crack growth. Residual stresses can be introduced in fabricated components by a variety of means and a number of methods such as laser surface treatment, cold expanded hole, and shot peening. Neutrons diffraction measurements of residual stress were performed at a pulsed neutron source (ISIS, Didcot, UK), on shot peened plates of nickel base superalloy Udimet 720 and titanium alloy IMI 834. The stress intensity factor (K) of residual stress was evaluated by finite element modeling and weight function method. Finite element modeling of a 2D plate with a single edge-notch was applied and, due to symmetry only half of the plate was actually modeled. The stress intensity factor (K) was evaluated for both case of remote tension stress and residual stress. Crack surface overlapping, which is physically unacceptable, was noted for small cracks under residual and boundary lading. Overlap correction was proposed and applied in order to obtain reliable values for (K). (author)

  19. Early weight-bearing after periacetabular osteotomy leads to a high incidence of postoperative pelvic fractures.

    Science.gov (United States)

    Ito, Hiroshi; Tanino, Hiromasa; Sato, Tatsuya; Nishida, Yasuhiro; Matsuno, Takeo

    2014-07-11

    It has not been shown whether accelerated rehabilitation following periacetabular osteotomy (PAO) is effective for early recovery. The purpose of this retrospective study was to compare complication rates in patients with standard and accelerated rehabilitation protocols who underwent PAO. Between January 2002 and August 2011, patients with a lateral center-edge (CE) angle of rehabilitation protocol. In 65 patients (76 hips) with the accelerated rehabilitation protocol, postoperative strengthening of the hip, thigh and core musculature was begun on the day of surgery as tolerated. The exercise program included active hip range of motion, and gentle isometric hamstring and quadriceps muscle sets; these exercises were performed for 30 minutes in the morning and 30 minutes in the afternoon with a physical therapist every weekday for 6 weeks. Full weight-bearing with two axillary crutches started on the day of surgery as tolerated. Complications were evaluated for 2 years. The clinical results at the time of follow-up were similar in the two groups. The average periods between the osteotomy and full-weight-bearing walking without support were 4.2 months and 6.9 months in patients with the accelerated and standard rehabilitation protocols (P rehabilitation protocol could achieve earlier recovery of patients. However, postoperative fractures of the ischial ramus and posterior column of the pelvis were more frequently found in patients with the accelerated rehabilitation protocol (8/76) than in those with the standard rehabilitation protocol (1/80) (P = 0.013). The accelerated rehabilitation protocol seems to have advantages for early muscle recovery in patients undergoing PAO; however, postoperative pelvic fracture rates were unacceptably high in patients with this protocol.

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

    International Nuclear Information System (INIS)

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

    2009-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-07-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-10-15

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

  3. Fracture properties of hydrided Zircaloy-4 cladding in recrystallization and stress-relief anneal conditions

    Energy Technology Data Exchange (ETDEWEB)

    Hsu, Hsiao-Hung, E-mail: hhhsu@iner.gov.tw [Institute of Nuclear Energy Research (INER), Lungtan Township, Taoyuan County 325, Taiwan (China); Institute of Materials Engineering, National Taiwan Ocean University, Keelung 202, Taiwan (China); Tsay, Leu-Wen [Institute of Materials Engineering, National Taiwan Ocean University, Keelung 202, Taiwan (China)

    2012-03-15

    In this work, the stress-relieved (SRA) and recrystallized (RXA) Zircaloy-4 cladding specimens were hydrogen-charged to the target concentration of 300 wppm and then manufactured into X-specimens for fracture toughness test. The hydrogen embrittlement susceptibility of Zircaloy-4 cladding specimens in both SRA and RXA conditions were investigated. At the hydrogen concentration level of 300 wppm, J-integral values for RXA cladding were higher than those for SRA cladding at both 25 Degree-Sign C and 300 Degree-Sign C. The formation of brittle zirconium hydrides had a significant impact on the fracture toughness of Zircaloy-4 cladding in both SRA and RXA states, especially at 25 Degree-Sign C. Among all the tests, SRA cladding tested at 25 Degree-Sign C exhibited a great loss of the fracture toughness. The micrographic and fractographic observations further demonstrated that the fracture toughness of Zircaloy-4 cladding would be improved by the coarse grains in RXA cladding, but degraded by zirconium hydrides precipitated along the grain boundary.

  4. The Incidence of Posttraumatic Stress Disorder After Floods: A Meta-Analysis.

    Science.gov (United States)

    Chen, Long; Liu, Aizhong

    2015-06-01

    This study analyzes the incidence of posttraumatic stress disorder (PTSD) among flood victims, between different flood intensities, and between different time points after a flood. A search of several electronic literature databases was conducted to collect data on the incidence of PTSD after a flood. Loney criteria for research quality were used to evaluate the quality of selected search results. The combined incidence of PTSD was estimated using the Freeman-Tukey double arcsine transformation method. Subgroup analyses were conducted on different trauma intensities and different time points after a flood. Sensitivity analysis was performed to evaluate the impact of research quality. Fourteen articles were included in this meta-analysis, including a total of 40 600 flood victims; 3862 victims were diagnosed with PTSD. The combined incidence of PTSD was 15.74%. The subgroup analyses showed that the incidence of PTSD in victims who experienced severe and moderate flood intensity was higher than that in victims who experienced mild flood intensity. The incidence of PTSD was lower at 6 or more months after a flood (11.45%) than within 6 months (16.01%) of a flood. In conclusion, the incidence of PTSD among floods of different trauma intensities was statistically significant.

  5. Mean load effect on fatigue of welded joints using structural stress and fracture mechanics approach

    International Nuclear Information System (INIS)

    Kim, Jong Sung; Kim, Cheol; Jin, Tae Eun; Dong, P.

    2006-01-01

    In order to ensure the structural integrity of nuclear welded structures during design life, the fatigue life has to be evaluated by fatigue analysis procedures presented in technical codes such as ASME B and PV Code Section III. However, existing fatigue analysis procedures do not explicitly consider the presence of welded joints. A new fatigue analysis procedure based on a structural stress/fracture mechanics approach has been recently developed in order to reduce conservatism by erasing uncertainty in the analysis procedure. A recent review of fatigue crack growth data under various mean loading conditions using the structural stress/fracture mechanics approach, does not consider the mean loading effect, revealed some significant discrepancies in fatigue crack growth curves according to the mean loading conditions. In this paper, we propose the use of the stress intensity factor range ΔK characterized with loading ratio R effects in terms of the structural stress. We demonstrate the effectiveness in characterizing fatigue crack growth and S-N behavior using the well-known data. It was identified that the S-N data under high mean loading could be consolidated in a master S-N curve for welded joints

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

    Science.gov (United States)

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

    2016-09-01

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

  7. Longitudinal stress fractures of the tibia: diagnosis by magnetic resonance imaging

    International Nuclear Information System (INIS)

    Umans, H.R.; Kaye, J.J.

    1996-01-01

    Previous works describe magnetic resonance (MR) imaging characteristics of stress fractures. This report focusses on MR imaging of longitudinal stress fractures of the tibia. Six cases are presented in which a longitudinal linear abnormal marrow signal was detected in the middle and distal parts of the tibial shaft. Five patients were imaged using a 1.5 Tesla MR unit. Axial, sagittal and coronal T1 and T2-weighted or fat suppressed proton density fast spin echo images were obtained in all but one patient. One patient was imaged using a 0.5 Tesla MR unit with axial and coronal T1- and T2-weighted sequences. Initial conventional radiographs seen at clinical presentation were interpreted as normal in all cases. Two patients underwent radionuclide bone scan, and one patient was imaged with CT prior to MR imaging. In each instance, MR imaging demonstrated linear marrow signal abnormalities orientated along the long axis of the tibial shaft. Endosteal and periosteal callus was identified on axial images. In all cases, MR imaging clearly demonstrated a fracture extending through one cortex with abnormal signal in both the marrow cavity as well as adjacent soft tissues indicating edema. (orig./MG)

  8. Longitudinal stress fractures of the tibia: diagnosis by magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Umans, H.R. [Dept. of Radiology, Albert Einstein Coll. of Medicine and Montefiore Medical Center, Bronx, NY (United States); Kaye, J.J. [The Hospital for Special Surgery, New York, NY (United States)

    1996-05-01

    Previous works describe magnetic resonance (MR) imaging characteristics of stress fractures. This report focusses on MR imaging of longitudinal stress fractures of the tibia. Six cases are presented in which a longitudinal linear abnormal marrow signal was detected in the middle and distal parts of the tibial shaft. Five patients were imaged using a 1.5 Tesla MR unit. Axial, sagittal and coronal T1 and T2-weighted or fat suppressed proton density fast spin echo images were obtained in all but one patient. One patient was imaged using a 0.5 Tesla MR unit with axial and coronal T1- and T2-weighted sequences. Initial conventional radiographs seen at clinical presentation were interpreted as normal in all cases. Two patients underwent radionuclide bone scan, and one patient was imaged with CT prior to MR imaging. In each instance, MR imaging demonstrated linear marrow signal abnormalities orientated along the long axis of the tibial shaft. Endosteal and periosteal callus was identified on axial images. In all cases, MR imaging clearly demonstrated a fracture extending through one cortex with abnormal signal in both the marrow cavity as well as adjacent soft tissues indicating edema. (orig./MG)

  9. Effect of yield stress matching on ductile fracture behavior of girth welds for X line pipe

    Energy Technology Data Exchange (ETDEWEB)

    Motohashi, Hiroyuki; Hagiwara, Naoto [Tokyo Gas Co., Ltd. (Japan)

    2005-07-01

    This paper describes the effects of yield stress matching on the ductile fracture behavior of girth welded joints for X linepipes. Three welded joints wer