Fracture Patterns Research Articles

Ankle fracture surgery performed by orthopaedic residents without supervision has comparable outcomes to surgery performed by fellowship trained orthopaedic surgeons.

Unstable fractures often necessitate open reduction and internal fixation (ORIF), which generally yield favourable outcomes. However, the impact of surgical trainee autonomy on healthcare quality in these procedures remains uncertain. We hypothesized that surgery performed solely by residents, without supervision or participation of an attending surgeon, can provide similar outcomes to surgery performed by trauma or foot and ankle fellowship-trained orthopaedic surgeons. A single-center cohort of an academic level-1 trauma center was retrospectively reviewed for all ankle ORIF between 2015 and 2019. Data were compared between surgery performed solely by post-graduate-year 4 to 6 residents, and surgery performed by trauma or foot and ankle fellowship-trained surgeons. Demographics, surgical parameters, preoperative and postoperative radiographs, and primary (mortality, complications, and revision surgery) and secondary outcome variables were collected and analyzed. Univariate analysis was performed to evaluate outcomes. A total of 460 ankle fractures were included in the study. Nonoperative cases and cases operated by senior orthopaedic surgeons who are not trauma or foot and ankle fellowship-trained orthopaedic surgeons were excluded. The average follow-up time was 58.4 months (SD ± 12.5). Univariate analysis of outcomes demonstrated no significant difference between residents and attendings in complications and reoperations rate (p = 0.690, p = 0.388). Sub-analysis by fracture pattern (Lauge-Hansen classification) and the number of malleoli involved and fixated demonstrated similar outcomes. surgery time was significantly longer in the resident group (p < 0.001). The current study demonstrates that ankle fracture surgery can be performed by trained orthopaedic surgery residents, with similar results and complication rates as surgery performed by fellowship-trained attendings. These findings provide valuable insights into surgical autonomy in residency and its role in modern clinical training and surgical education. Level III - retrospective cohort study.

Simulative investigation of the required level of geometrical individualization of the lumbar spines to predict fractures.

Injury mechanisms of the lumbar spine under dynamic loading are dependent on spine curvature and anatomical variation. Impact simulation with finite element (FE) models can assist the reconstruction and prediction of injuries. The objective of this study was to determine which level of individualization of a baseline FE lumbar spine model is necessary to replicate experimental responses and fracture locations in a dynamic experiment.Experimental X-rays from 26 dynamic drop tower tests were used to create three configurations of a lumbar spine model (T12 to L5): baseline, with aligned vertebrae (positioned), and with aligned and morphed vertebrae (morphed). Each model was simulated with the corresponding loading and boundary conditions from dynamic lumbar spine experiments. Force, moment, and kinematic responses were compared to the experimental data. Cosine similarity was computed to assess how well simulation responses match the experimental data. The pressure distribution within the vertebrae was used to compare fracture risk and fracture location between the different models.The positioned models replicated the injured spinal level and the fracture patterns quite well, though the morphed models provided slightly more accuracy. However, for impact reconstruction or injury prediction, the authors recommend pure positioning for whole-body models, as the gain in accuracy was relatively small, while the morphing modifications of the model require considerably higher efforts. These results improve the understanding of the application of human body models to investigate lumbar injury mechanisms with FE models.

PROPOSAL OF A MODIFIED TIP APEX DISTANCE FOR PREDICTION OF LAG SCREW CUT-OUT IN TROCHANTERIC HIP FRACTURES

Lag screw cut-out is a serious complication of dynamic hip screw fixation in trochanteric hip fractures. Lag screw position is recognised as a crucial factor influencing the occurrence of lag screw cut-out. We propose a modification of the Tip Apex Distance (TAD) and hypothesize that it could enhance the reliability of predicting lag screw cut-out in these injuries.A retrospective study of hip fracture cases was conducted from January 2018 to July 2022. A total of 109 patients were eligible for the final analysis. The modified TAD was measured in millimetres, based on the sum of the traditional TAD in the lateral view and the net value of two distances in the anteroposterior (AP) view. The first distance is from the lag screw tip to the opposite point on the femoral head along the lag screw axis, while the second distance is from that point to the femoral head apex. The first distance is a positive value, whereas the second distance is positive if the lag screw is superior and negative if it is inferior. Receiver operating characteristic (ROC) curve analysis was used to assess the reliability of various parameters for evaluating the lag screw position within the femoral head.Factors such as reduction quality, fracture pattern according to the AO/OTA classification, TAD, Calcar-Referenced TAD, Axis Blade Angle, Parker’s ratio in the AP view, Cleveland Zone 1, and modified TAD were statistically associated with lag screw cut-out. Among the tested parameters, the novel parameter exhibited 90.1% sensitivity and 90.9% specificity for predicting lag screw cut-out at a cut-off value of 25 mm, with a p-value &lt; 0.001.The modified TAD demonstrated the highest reliability in predicting lag screw cut-out. A value of 25 mm may potentially reduce the risk of lag screw cut-out in trochanteric hip fractures.

Low avascular necrosis rates in femoral neck fractures: efficacy of cannulated screw fixation.

Cannulated screw fixation for femoral neck fractures is often limited by concerns of avascular necrosis (AVN) occurring, historically seen in 5-40% of fixed intracapsular fractures. This study aims to assess the outcomes, particularly the AVN rate, associated with current surgical techniques within our unit. We conducted a single-center cross-sectional study, manually searching operative records between July 14, 2014, and December 1, 2018, identifying patients with intracapsular fractured neck of femur fixed with cannulated screws, with a minimum of two years follow-up. Patient records and radiographs were reviewed for clinical and radiographic diagnoses of AVN, non-union, post-operative metalwork infection, and screw penetration of the head. Additionally, fracture pattern and displacement, screw configuration, reduction techniques, and adequacy of reduction were recorded, with radiographs independently analyzed by four orthopedic surgeons. Fifty-six patients were included; average age of 67 years (range 30-100). Forty-two patients (75%) sustained displaced fractures and 14 patients (25%) had undisplaced fractures. Two (4%) patients developed AVN, with no cases of non-union, post-operative metalwork infection or screw penetration of the head. Eight patients (14%) sustained a high-energy injury, though none of these patients developed AVN. All fractures required closed reduction; no open reductions performed. Twenty-seven (64%) of reductions were adequate. Our observed AVN rate is notably lower than the widely reported figures, even among a significant proportion of displaced fractures that were fixed. This study underscores that with adequate fixation, cannulated screws represent an excellent option for treating intracapsular neck of femur fractures, even in cases of displaced fracture patterns with imperfect reduction.

The Influence of e-glass epoxy composite laminate material application on the crack pattern of cylinder concrete column cross-section

In order to better understand the phenomenon of applying GEC reinforcement to RCC based on the percentage of surface crack pattern (PCP), this research will use e-glass epoxy composite laminate (GEC) to obtain the damage pattern of reinforced concrete column specimens (RCC) utilizing GEC. Additionally, it will compare the splitting tensile strength (STS) and SCP. In accordance with ASTM C496 guidelines, the RCC specimens used in this investigation had a cylindrical shape and measured 150 mm in length and 50 mm in diameter. GEC material, consisting of 0–4 layers of woven e-glass fiber sheets, was applied as an extra layer on top of the RCC. In compliance with ASTM C496 guidelines, a Universal Testing Machine (UTM) was used to perform the split tensile test. With the aid of Adobe Photoshop software, the Histogram approach was used to calculate the crack pattern's proportion. The study's findings demonstrated that the specimens reinforced with four layers of GEC exhibited the highest damage pattern. This suggests that the reinforced specimens must be subjected to a sizable load in order to be damaged. Hence, the damage that occurs in the specimens can be lessened by applying GEC layers on RCC. Further information about the performance of RCC reinforced with GEC is also provided by a comparison of the splitting tensile strength and the percentage of fracture pattern

Effect of cementation on the mechanical response of sands using acoustic emission technique

This study investigates the impact of cementation on the mechanical behavior of sands with various cement content (CSR) in drained triaxial compression, employing both Acoustic Emission (AE) and Environmental Scanning Electron Microscopy (ESEM) measurements. The experimental findings, encompassing quantitative statistics of stress-strain relations, microstructure variations, and AE characteristics, demonstrate that: the addition of CSR from 1% to 20% leads to an exponential rise in peak strength and stiffness, marking a transition from ductile to brittle mechanical failure, which is pinpointed between CSR levels of 5% to 10%. AE characteristics unveil an upward-opening parabola of normalized AE hits with CSR, a clear transition zone identification, and three distinct types of AE rate evolutions corresponding to failure patterns of ductile bulging, shear banding, and brittle fracturing, respectively. It suggests an intimate correlation with the intrinsic differences in micro-mechanical behaviors and AE propagation properties of cemented sands with varying CSRs. Notably, the bulging and shear banding processes are divided by AE into three stages, whereas fracturing is characterized into five stages. Two precursory AE anomalies associated with incipient failure and complex failure modes are observed, emphasizing the advantage of using AE to reflect the internal micro-mechanical behavior of cemented sands over conventional stress-strain manifestations.

Pediatric patients with facial fractures: a retrospective study.

Epidemiology of maxillofacial injuries vary depending on geographic location, culture and socioeconomic condition. This study assessed etiology and pattern of facial fractures in children reported at Burdwan Dental College and Hospital, Burdwan, West Bengal, India. Clinical files of 206 children with facial fractures were evaluated retrospectively. Diagnosis of fractures were confirmed by radiographic examination. Study period was from July 2018 to June 2022. Data collected were age and sex of the patient, site of fracture, and etiology of trauma. Descriptive statistics were used for statistical analysis with a P-value less than 0.05. There were 127 (61.7%) males and 79 (38.3%) females with a male to female ratio of 1.6:1. Within the study sample, the majority of facial fractures (n= 146, 70.9%) belonged to 6-to-9-year age group. Overall, falls (44.2%) and motor vehicles accidents (31.5%) were the two leading causes of trauma. Mandible fracture was the most common, accounting for 72.8% of cases. 74 patients (35.9%) with facial fracture had dental injuries. Male predominance in facial fracture is seen. With age, frequency of facial fractures tends to increase. Falls are the main cause of facial fracture and mandible is the most common anatomic location.

Fracturing behavior and damage model of spatial-rotation fissured sandstone: An experimental study on freeze–thaw and fatigue loads coupling

Earthquake exposure can greatly weaken the mechanical properties and affect the failure process of fractured rocks in cold regions. Creep tests of the spatial-rotation (SR) fissured rock with sandstone as the bedrock under different fatigue combinations and angles were carried out. The effects of freeze–thaw and fatigue loads (FT-FLs) on the deformation behaviour of samples, for example, creep, fatigue deformation, frost heave pressure, and creep rate, were explored. The mechanical responses and failure modes of the specimens were analysed in detail. Based on the experimental results, a new coupled damage model was explored. The results show that in addition to the typical creep stage, the rheological curve also included the phase of disturbance deformation under fatigue loading. The attenuation rates of the rock samples had downward trends with increasing load level under the fatigue combinations and angles, and these decreasing trends had linear characteristics. Moreover, the fatigue rate values increased gradually as the fatigue amplitude, fissure angle and rotation angle increased. In addition, with the change in the fissure and rotation angles, the curves of the tensile crack number had inverted U-shaped trends. The 3D fracture patterns under fatigue were dominated by vertical and vertical-lateral penetration, in which secondary fissure expansion also occurred at different angles. A combined damage model based on the damage variable of freeze–thaw cycles, fatigue loading, and spatial rotation of fissures was established. Compared with test data and other models, the coupled model has good accuracy in describing the entire failure process of specimens under FT-FLs and provides a new framework for the stability of fractured rock masses.

Fracture Resistance of Simulated Immature Teeth Filled with Three Types of Calcium Silicate Cement after Intracanal Medication with Ca(OH)2: An Ex Vivo Study.

The aim of this study was to evaluate the 1-day fracture resistance of simulated immature teeth with an apical plug with ProRoot MTA, MTA Angelus, and RetroMTA after calcium hydroxide intracanal medication. Sixty extracted, single-rooted human mandibular premolars were randomly divided into six groups of 10 teeth each. Firstly, to standardize the 9 mm root length, the crowns were cut off at and 9 mm below the cementoenamel junction transversely. Simulations for immature apices were carried out by using No. 1-6 Peeso reamers to pass through the apex to obtain a diameter of 1.7 mm at the apical opening. One group served as a negative control without any treatment, while the other groups received 30 days of calcium hydroxide intracanal medication. Four groups were plugs with 4 mm of ProRoot MTA, MTA Angelus, RetroMTA, and gutta-percha, respectively. The last one was served as a positive control group without filling inside. After 1 day of incubation, specimens were vertically loaded in a universal testing machine at a crosshead speed of 1 mm/min until fracture occurred. The peak load to fracture (Newton) and fracture pattern were recorded. A one-way analysis of variance (ANOVA) followed by Tukey's HSD test was used for data analysis. The highest mean load to fracture was shown in the negative control group (543.33 ± 37.17 N), followed by ProRoot MTA (432.82 ± 68.06 N), MTA Angelus (396.92 ± 59.93 N), RetroMTA (389.08 ± 56.25 N), and gutta-percha (283.28 ± 43.40 N), and the lowest belonged to the positive control group (239.98 ± 27.19 N). The significant differences were found between both the control and experimental groups with an apical plug with calcium silicate cement (p  < 0.05). There were no significant differences among those three apical plugs (p  > 0.05). Apical plugs with ProRoot MTA, MTA Angelus, and RetroMTA had an immediate strengthening effect on simulated immature teeth after calcium hydroxide intracanal medication had been used.

Numerical Investigation of Stratified Slope Failure Containing Rough Non-Persistent Joints Based on Distinct Element Method

To address the critical issue of slope stability in jointed rock masses with complex and rough structural planes, a rough joint network model using the Fourier transform was proposed and applied to the Shilu open pit mine. The on-site structural plane survey results were combined with MATLAB and PFC2D to establish numerical models for slope stability analysis considering both linear-jointed and rough-jointed rock slopes. By comparing the slip body and fracture distribution, it was found that the rough-jointed slope was stabler than the linear-jointed slope. In addition, the fracture patterns and slip displacement were significantly influenced by the inclination and undulation of the bedding planes. Slip failure patterns occurred when the angle of inclination was set at 60°. The joints played a crucial role in inducing the shear strength of slope rock masses, and the slide area was mainly observed in the shallow slope surface for inclination angles of 0° and 45°, and in the middle deep area for 60° and 90°. These results demonstrated the importance of considering rough non-persistent fractures when developing a new numerical model for slope failure modes.

Femoral Neck Fractures with Concomitant Ipsilateral Femoral Shaft Fractures in Young Adults &lt;50 Years Old: A Multicenter Comparison of 80 Cases vs. Isolated Femoral Neck Fractures

OBJECTIVES: To analyze patients, injury pattern, and treatment of femoral neck fractures in young patients with femoral neck fractures associated with shaft fractures (assocFNFs) to improve clinical outcomes. The secondary goal was to compare this injury pattern to that of young patients with isolated femoral neck fractures (isolFNFs). METHODS: Design: Retrospective multicenter cohort series Setting: 26 North American Level-1 trauma centers Level of Evidence: Level III Patient Selection Criteria: Skeletally mature patients, &lt;50 years old, treated with operative fixation of a femoral neck fracture with or without an associated femoral shaft fracture. Outcome Measures and Comparisons: The main outcome measurement was treatment failure defined as nonunion, malunion, avascular necrosis, or subsequent major revision surgery. Odds ratios for these modes of treatment were also calculated. RESULTS: Eighty assocFNFs and 412 isolFNFs evaluated in the study were different in terms of patients, injury patterns, and treatment strategy. AssocFNF patients were younger (33.3±8.6 vs. 37.5±8.7 years old, p&lt;0.001), greater in mean BMI (29.7 vs. 26.6, p&lt;0.001), and more frequently displaced (95% vs. 73%, p&lt;0.001), “vertically oriented” Pauwels’ type 3, p&lt;0.001 (84% vs. 43%) than for isolFNFs, with all p values &lt;0.001. AssocFNFs were more commonly repaired with an open reduction (74% vs. 46%, p&lt;0.001) and fixed angle implants (59% vs. 39%) (p&lt;0.001). Importantly, treatment failures were less common for assocFNFs compared to isolFNFs (20% vs. 49%, p&lt;0.001) with lower rates of failed fixation/ nonunion and malunion (p&lt;0.001 and p=0.002, respectively). Odds of treatment failure (OR=0.270, 95% CI=0.15-0.48, p&lt;0.001), nonunion (OR=0.240, 95% CI=0.10-0.57, p&lt;0.001), and malunion (OR=0.920, 95% CI=0.01-0.68, p=0.002) were also lower for assocFNFs. Excellent or good reduction was achieved in 84.2% of assocFNFs reductions and 77.1% in isolFNFs (p=0.052). AssocFNFs treated with fixed angled devices performed very well, with only 13.0% failing treatment compared to 51.9% in isolFNFs treated with a fixed angle constructs (p=&lt;0.001) and 33.3% in assocFNFs treated with multiple cannulated screws (p=0.034). The study also identified the so-called “shelf sign”, a transverse ≥6mm medial-caudal segment of the neck fracture (forming an acute angle with the vertical fracture line) in 54% of assocFNFs and only 9% of isolFNFs (p&lt;0.001). AssocFNFs with a shelf sign failed in only 5 of 41 (12%) of cases. CONCLUSIONS: AssocFNFs in young patients are characterized by different patient factors, injury patterns, and treatments, than for isolFNFs, and have a relatively better prognosis despite the need for confounding treatment for the associated femoral shaft injury. Treatment failures among assocFNFs repaired with a fixed angled device occurred at lower rate compared to isolFNFs treated with any construct type, and assocFNFs treated with multiple cannulated screws. The radiographic “shelf sign” was found as positive prognostic sign in more than half of assocFNFs and predicting a high rate of successful treatment. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Overview of Pelvic Ring Fracture Patients: Observational Study in the Emergency Department at Dr. Kariadi General Hospital, Semarang, Indonesia

Background: Although the incidence of pelvic fractures is only 7% of all trauma, the mortality reaches 21.5%. Management of pelvic fractures remains a challenge because it is often a polytrauma that requires multidisciplinary management and large resources. Knowledge of the characteristics of patients with pelvic fractures is expected to help in management and reduce mortality. Methods: This observational study was conducted retrospectively with a population and sample of all pelvic fracture patients in the emergency room at Dr. Kariadi Hospital Semarang for the period January 2021 to December 2023. The characteristics observed included gender, age, fracture classification, etiology, trauma score, fracture pattern, and management. and output. The data obtained is then presented descriptively. Results: A total of 34 patients with pelvic fractures were recorded in this study. There were 16 male patients and 18 female patients. A total of 3 patients were less than 17 years old, 19 patients were 17-34 years old, 7 patients were 35-52 years old and 3 patients were more than 52 years old. The most common cause of pelvic fractures was traffic accidents (KLL) with 28 patients, followed by work accidents (4 patients) and other trauma (2 patients). Based on the Young-Burgess classification, the most common pelvic fracture pattern was LC1 (11 patients), followed by APC1 (3 patients), APC2 (4 patients), APC3 (3 patients), LC2 (2 patients), LC3 (6 patients), VS (4 patients), and CM (1 patient). A total of 4 patients had an ISS score of 1-8, 8 patients had an ISS score of 9-15, 9 patients had an ISS score of 16-25, and 13 patients had an ISS score of more than 25. The most common accompanying injury was long bone fracture (15 patients), head injury in 10 patients, abdominal trauma in 9 patients, and thorax trauma in 4 patients. Operative treatment was carried out in 21 patients, while 13 other patients were treated non-operatively. Of the 34 patients, 8 patients died and 26 others were discharged in good condition. Conclusion: Most pelvic fractures occur at the age of 17-34 years and the most common cause is KLL. All pelvic fracture patients had concomitant injuries and the majority of patients had unstable fractures that required operative treatment. Mortality due to pelvic fracture and/or accompanying injuries is 23.5%.

Dietary inflammatory pattern and risk of hip fracture in the Nurses’ Health Study

SummaryOur immune system activity is impacted by what we eat and can influence fracture risk under certain conditions. In this article, we show that postmenopausal women with a pro-inflammatory dietary pattern have an increased risk of hip fracture.PurposeThe immune system influences bone homeostasis and can increase the risk of fracture under certain pro-inflammatory conditions. Immune system activity is impacted by dietary patterns. Using the empirical dietary inflammatory pattern (EDIP), we investigated whether postmenopausal women with a pro-inflammatory dietary pattern had an increased risk of hip fracture.MethodsThe study population consisted of postmenopausal women participating in the Nurses’ Health Study from 1980 to 2014, who reported information on lifestyle and health, including hip fractures, on biennial questionnaires, while semiquantitative food frequency questionnaires (FFQs) were completed every fourth year. Hazard ratios (HR) for hip fracture were computed using Cox proportional hazards models, adjusting for potential confounders.ResultsEDIP was calculated using intake information from the FFQ for 87,955 postmenopausal participants, of whom 2348 sustained a non-traumatic hip fracture during follow-up. After adjustment for confounders, there was a 7% increase in the risk of hip fracture per 1 SD increase in EDIP (HR 1.07, 95% CI 1.02–1.12), and the uppermost quintile had a 22% greater risk compared to the lowest (HR 1.22, 95% CI 1.06–1.40). For the separate components of the EDIP, we found that higher intakes of low-energy beverages (diet sodas) were independently associated with an increased risk of hip fracture, while higher intakes of green leafy vegetables were associated with a reduced risk.ConclusionA pro-inflammatory dietary pattern was associated with an increased risk of hip fracture among postmenopausal women.

THE BIGGER, THE BETTER? TWO-RING CIRCULAR FRAMES AND DURATION OF TREATMENT IN THE MANAGEMENT OF TIBIAL FRACTURES: A RETROSPECTIVE COHORT STUDY

IntroductionFrame configuration for the management of complex tibial fractures is highly variable and is dependent not only on fracture pattern and soft tissue condition but also surgeon preference. The optimal number of rings to use when designing a frame remains uncertain. Traditionally, larger, stiffer constructs with multiple rings per segment were thought to offer optimal conditions for bone healing, however, the concept of reverse dynamisation questions this approach.Materials &amp; MethodsWe compared clinical outcomes in 302 consecutive patients with tibial fractures treated in our unit with either a two-ring circular frame or a three-or-more-ring (3+) frame. The primary outcome measure was time spent in frame. Secondary outcomes were the incidence of malunion and the need for further surgical procedures to achieve bone union. The groups were evenly matched for age, co-morbidities, energy of injury mechanism, fracture classification, post-treatment alignment and presence of an open fracture.ResultsThe mean time in frame was 168 days for the 2-ring group and 200 days for the 3+ rings group (p=0.003). No significant difference was found in the rate of malunion (p=0.428) or the requirement for secondary surgical intervention to achieve union (p=0.363). No significant difference in time in frame was found between individual surgeons.ConclusionsThis study finds that 2-ring frame constructs are a reliable option associated with significantly shorter duration of treatment and no increase in rates of adverse outcomes compared with larger, more complex frame configurations. Although this study cannot identify the underlying cause of the difference in treatment time between frame designs, it is possible that differences in mechanical stability lead to a more favourable strain environment for fracture healing in the 2-ring group.

Numerical investigation of mechanical responses and failure features of coal measure strata using combined finite-discrete element method

Investigating the mechanical responses and failure features of the deep coal measure strata (CMS) is essential for designing hydraulic fracturing treatments and preventing geological dynamic hazards in underground engineering. In this paper, a three-dimensional CMS model is established by the combined finite-discrete element method (FDEM). The mechanical properties, stress evolutions and failure features of the CMS with different lithological combinations (sandstone-coal-sandstone (SCS), sandstone-coal-mudstone (SCM) and mudstone-coal-mudstone (MCM)) and thickness ratios are investigated under the uniaxial compressive condition. Results indicate that the SCS combination exhibits the highest uniaxial compressive strength (UCS) and elastic modulus, followed by the SCM and MCM combinations. The mechanical properties of the CMS are predominantly determined by the softer coal layer. The mechanical contrasts in elastic modulus and Poisson’s ratio between adjacent layers cause the generation of additional compressive stress in the softer layer and additional tensile stress in the stiffer layer. Therefore, the softer coal layer exhibits the shear-dominated failure pattern while the stiffer sandstone/mudstone layer displays the tensile-dominated failure pattern in the CMS. Furthermore, as the thickness ratio of the coal layer increases, the UCS, elastic modulus, and interfacial constraint stress decrease in the CMS. Additionally, the UCS and stress–strain relationship in the post-peak stage exhibit the noticeable size effect, whereas the mechanical behaviors in the pre-peak stage and the ultimate fracture patterns show the opposite. The elastic modulus and interfacial constraint stress obtained by the FDEM simulation match well with those calculated by theoretical models. The key findings of this paper can provide fundamental understanding and reliable parameters for multi-scale geomechanical modeling in petroleum and mining engineering.

[Basic principles of surgical treatment of distal radius fractures].

Distal radius fractures are one of the most frequent fractures of the upper extremities. The decision for conservative or surgical treatment is made after appropriate diagnostics using conventional radiographic and usually computed tomography imaging examinations. If the indications for surgical treatment are present, various options for reduction and fixation are available. The spectrum ranges from closed to open procedures up to accompanying arthroscopic support. Appropriate preoperative patient education about the procedure and the planned postinterventional treatment is essential. The goal of treatment is to restore wrist function while maintaining mobility and strength with alow risk of complications. All surgical procedures share the principle of reduction to restore anatomical relationship followed by fixation. Closed procedures include fixation with Kirschner wires and the construction of an external fixator. Volar locking plate osteosynthesis has become established in recent years as the method of choice for the majority of the fractures to be treated. For special fracture patterns and the treatment of accompanying injuries, arthroscopic support can be indicated. There is no uniform consensus on the best choice of procedure. This article discusses the possible procedures including the approaches, fixation techniques and specific follow-up treatment.

Pediatric foot fractures on radiographs: distribution and predictors of surgery.

To examine the distribution and characteristics of pediatric foot fractures on radiographs with respect to age and skeletal maturation, and to identify predictors of surgery. This retrospective study included children (≤ 18 years) with foot fractures, who underwent radiographic examinations (2020-2022). Electronic medical records were reviewed to obtain demographic and clinical data. Fracture characteristics, including anatomic location, presence of displacement, angulation, articular involvement, and, if skeletally immature, physeal involvement and Salter-Harris fracture pattern were collected. Logistic regression models were used to identify predictors of surgery. 1,090 (596-boys, 494-girls; mean age, 11.0 ± 4.0 years) patients with 1,325 (59.8% metatarsal, 33.8% phalangeal, and 6.4% tarsal) fractures were included. Fractures of 1st metatarsal were more common among younger children whereas fractures of 2nd-4th and 5th metatarsals were more common among older children (median ages: 5.9 years vs. 10.3 years and 12.4 years, p < 0.001). Intra-articular fractures were more common among maturing and mature than immature bones (25.3%and 20.4% vs. 9.9%, p < 0.001). Physeal involvement was uncommon (162/977, 16.6%) and the most common pattern was Salter-Harris type II (133/162, 82.1%). A minority (47/1090, 4.3%)of patients required surgery and independent predictors of surgery included physeal involvement (OR = 5.12, 95%CI: 2.48-10.39, p < 0.001), multiple fractures (OR = 3.85, 95%CI: 1.67-8.53, p = 0.001), fracture displacement (OR = 9.16, 95%CI:4.43-19.07, p < 0.001), and articular involvement (OR = 2.72, 95%CI:1.27-5.72, p = 0.008). Using these predictors, the likelihood for surgery ranged between 8.0% with 1 and 86.7% with 3 predictors. Pediatric foot fracture patterns differed based on age and regional skeletal maturation. Physeal involvement, multiple fractures, fracture displacement, and articular involvement were independent predictors of surgery in our study group.

Novel implant design for comminuted posterior wall acetabular fractures.

In recent years, the medical community has witnessed a notable increase in high-energy traumatic injuries, leading to a surge in complex fracture patterns that challenge existing treatment methodologies. Among these, the posterior approach to acetabular fractures stands out for offering direct visualization of the retro-acetabular surface, with current fixation methods relying on 3.5mm low-profile reconstruction plates and various other implants. Despite the effectiveness of these methods, there is a burgeoning demand for a singular, adaptable implant that not only streamlines the surgical process but also optimizes patient outcomes. In an innovative approach to address this need, three-dimensional (3D) models of the posterior acetabular wall were meticulously crafted using AutoCAD® software. The chosen material for the implant was 316L surgical steel for its durability and strength. The design of the implant featured a low-profile mesh structure, which was instrumental in facilitating osteosynthesis. This design allowed for the placement of screws of varying lengths in multiple directions, ensuring the initial reconstruction of the joint in an anatomical position without hindering the placement of the definitive implant. The primary objective was to secure the fixation and stabilization of the fracture by specifically targeting the smaller bone fragments. A comparative analysis was then conducted between this novel plate and a conventional 316L surgical steel, seven-hole, 3.5mm reconstruction plate through finite element analysis. The comparative analysis unveiled that both plates demonstrated comparable deformation capacities, with no significant differences in load-bearing capabilities observed. This finding suggests that the innovative plate can match the performance of traditional plates used in such surgeries. The finite element analysis revealed that the newly developed anatomical plate for posterior wall acetabular fractures meets the necessary physical and mechanical criteria for permanent implementation in patients with these fractures. This breakthrough represents a promising advancement that could simplify surgical procedures and potentially elevate patient outcomes. This study is classified as a Level II, diagnostic study.

Using calcaneal plates in fixation of comminuted posterior wall acetabular fractures with cranial or posterior extension: a prospective case series and novel technique.

This study aims to evaluate the outcomes of using calcaneal plate in fixation of comminuted posterior wall (PW) acetabular fractures especially that have cranial (dome) or posterior extension (posterior column edge), and to evaluate its safety. To our knowledge, this is the first study that utilizes this off label implant technique in fixation of such fracture. Twenty-two patients enrolled in the study with a minimum follow up of one year. After reducing the PW fragments sequentially, calcaneal plate was applied, fixing its distal part at ischial tuberosity upper ends using 3 screws in a triangular fashion, while its proximal part and radial wings were firmly fixed along the acetabular rim together with the classic longitudinal anchorage. Any fixation failure or head subluxation was recorded. Radiological outcome showed 18 cases scored as excellent, 2 were good, and 2 were poor. The functional outcome revealed 2 patients were excellent, 6 were very good and 14 were good. There was no loss of reduction or fixation failures throughout the follow up period. Calcaneal plate may offer an alternative method of fixation of comminuted PW fractures with acceptable radiological and functional results. Our study result may encourage the comprehensibility and replicability of this practice, however randomized multicentered studies should be conducted to validate this assumption. This method provides valuable trick strategy, stable and soft-tissue-friendly fracture fixation where modern implantations may be unavailable or of high cost. Calcaneal plates show some fascinating features that allow using them outside their field being flexible with large footprint area for fracture buttressing beside numerous hole choices with diverse paths providing suitable fixation, articular stability and wide zone of coverage in PW comminuted fracture patterns with cranial or posterior extensions. The plate proximal triangular configuration together with distal triangular screw fixation gives a stiff rigid anchorage and buttressing similar to a metal mesh covering and fixing any fragment numbers up to dome level.

Advanced tensile fracture analysis of alumina ceramics: Integrating hybrid finite-discrete element modeling with experimental insights

This study offers novel insights into the Mode I tensile response of an alumina ceramic through the use of computational modeling and the flattened Brazilian disk (FBD) experiments. A modified hybrid finite-discrete element method (HFDEM) is developed, integrating a coupled damage and friction cohesive model and a microscopic stochastic fracture model with a Weibull strength distribution by Monte Carlo simulation. The model is used to simulate direct tensile failure processes under quasi-static loading conditions, providing qualitative and quantitative predictions of direct tensile failure processes of an alumina ceramic. Concurrently, quasi-static flattened Brazilian disk tests (indirect tensile tests) are performed on a standard MTS machine coupled with a high-speed camera. The modified HFDEM model is also applied to reproduce the FBD experiments, and our simulated tensile strength is consistent with the experimental results. The results of the modified HFDEM model show three kinds of phenomena (i.e., “underestimation”, “reasonable estimation”, and “overestimation” of the indirect tensile strength) and four different types of associated fracture and fragment patterns of FBD testing. The integration of simulation and experimental results reveal relationships between fracture patterns, fragment geometry, tensile strength, and indirect tensile strength. The fracture and fragmentation patterns derived from our modified HFDEM model can be utilized to analyze the “tensile strength” measured in BD testing. Overall, this research offers important insights and direction for future Brazilian disk experiments and tensile strength assessments, enhancing our comprehension of ceramic failure mechanisms under tensile loadings.