Reconstruction Of Fractures Research Articles

Managing calcaneal fractures through modified sinus tarsi approach and headless screws fixation

The calcaneus is the most commonly fractured tarsal bone, and the treatment of patients with intraarticular calcaneal fractures remains controversial. Operative treatment utilizing extensile approaches provides excellent exposure of the fracture but is associated with high rates of wound complications. This case report discusses the application of the mini-open reduction technique through the modified sinus tarsi approach and fixation with headless cannulated screws for the reconstruction of an intra-articular tongue-type calcaneus fracture in a 67-year-old male patient who presented with a history of falling from a 2-meter height, sustained a dislocated intra-articular calcaneal fracture. Using a 2–3 cm lateral transverse incision, we reduced the fracture and percutaneously fixed it with two headless cannulated screws. The patient fully regained his activity level by the 3rd-month postoperatively. At the 9-month follow-up, foot and ankle functions were found to be satisfactory. Minimally invasive treatment of calcaneal fractures achieved through the modified sinus tarsi approach provides excellent fracture exposure and percutaneous fixation using headless cannulated screws ensures better outcomes.

Does a Point-of-Care 3-Dimensional Printer Result in a Decreased Length of Surgery for Orbital Fractures?

Utilization of point-of-care 3-dimensional printing (3DP) has decreased length of surgery in facial trauma. Little is known regarding 3DP's impact on length of surgery in orbital fracture. The purpose of this study was to compare length of surgery between 3DP/preadapted (3DPPA) orbital plates and intraoperative adapted plates (IOAP) for orbital fracture reconstruction. This was a prospective, non-blinded, randomized clinical study of consecutive subjects with orbital fractures presented to Grady Memorial Hospital in Atlanta, Georgia, between January 2018 and June 2021. Subjects ≥ 18years, unilateral fracture, no previous orbital surgery, and/or congenital craniofacial anomaly were included. We excluded subjects <18years and bilateral fractures. Primary predictor variable was the treatment approach. Randomization software was used, and subjects were randomized to 3DPPA or IOAP groups. Primary outcome variable was length of surgery in minutes. Secondary outcomes were the time required for plate insertion and fixation in minutes, operating room (OR) charges, and orbital volume (OV) calculation. Age, sex, race, etiology, laterality, location, dimension, indication for surgery, postoperative enophthalmos, and diplopia. Univariate and bivariate analyses were calculated. Statistical significance was P<.05. Twenty-five subjects met the inclusion criteria. Mean ages in 3DPPA and conventional IOAP groups were 41.5 (±9) and 38.2 (±10, P=.31), respectively. The mean length of surgery was 32.6 (±13.7) in 3DPPA and 53.3 (±12.8, P<.001) in conventional IOAP. The mean time required for plate insertion and fixation was 15.8n (±14.4) in 3DPPA and 41.4 (±9.4, P<.001) in conventional IOAP. The mean OR charges were $1,072.5 (±524.6) in 3DPPA and $1,757.3 (±422.6, P ≤ 0.001) in conventional IOAP. The mean calculated OV of uninjured and reconstructed orbit for the 3DPPA was 23.5 (±3.2)cm3 and 23 (±3.5, P=.37)cm3, respectively. The mean calculated OV of uninjured and reconstructed orbit for conventional IOAP was 28.6 (±3.6)cm3 and 22.8 (±2.6, P<.001)cm3, respectively. Using 3DP to produce a model that enables preoperative plate bending/adaptation reduces the length of surgery, decreases OR charges, and results in predictable OV.

Reconstruction of Chronic Monteggia Fracture with Radial Head Excision: A Case Report

Introduction: Chronic Monteggia fracture is a rare and clinically challenging condition, characterized by a non-union fracture of the proximal ulna with dislocation of the radial head. This case report presents the case of a 42-year-old woman with a chronic Monteggia fracture diagnosed 21 years after the initial injury, highlighting the importance of a careful patient history and radiographic investigation. Case presentation: A 42-year-old woman presented with left elbow pain and a history of significant trauma 21 years previously. Physical examination revealed limited range of motion and radiographic examination revealed a nonfused fracture of the proximal ulna with dislocation of the radial head. The patient underwent open reduction and internal fixation (ORIF) reconstruction of the ulna and excision of the radial head. Conclusion: Successful surgical reconstruction of chronic Monteggia fractures results in significant improvements in the patient's function and quality of life. This case report emphasizes the importance of early diagnosis and timely surgical intervention to prevent long-term complications and achieve optimal functional outcomes.

Periprosthetic Transpatellar Fracture Replacement With Autogenous Iliac Graft: A Technical Note.

Periprosthetic fractures involving total knee arthroplasty (TKA) components, particularly involving the patella, can present a significant challenge regarding orthopedic surgery. This technical note outlines an approach for the reconstruction of complicated periprosthetic transpatellar fractures, with poor bone stock, utilizing autogenous iliac graft. This kind of procedure requires careful preoperative evaluation of imaging, precise intraoperative planning, and strict postoperative management to achieve adequate postoperative results. The inventive option of utilizing an autogenous iliac graft for reconstructionsuggests its potential benefits in addressing the unique biomechanical demands of patellar fractures in TKA patients with poor bone stock. Key technical aspects of this approach are highlighted and include graft harvest, graft preparation, and fixation techniques. Overall, this technique can provide a golden standard bailout for periprosthetic transpatellar fracture reconstruction and potentially offer orthopedic surgeons a comprehensive framework for addressing this challenging clinical scenario.

Automatic bicipital groove identification in arthritic humeri for preoperative planning: A Random Forest Classifier approach

The bicipital groove is an important anatomical feature of the proximal humerus that needs to be identified during surgical planning for procedures such as shoulder arthroplasty and proximal humeral fracture reconstruction. Current algorithms for automatic identification prove ineffective in arthritic humeri due to the presence of osteophytes, reducing their usefulness for total shoulder arthroplasty. Our methodology involves the use of a Random Forest Classifier (RFC) to automatically detect the bicipital groove on segmented computed tomography scans of humeri. We evaluated our model on two distinct test datasets: one comprising non-arthritic humeri and another with arthritic humeri characterized by significant osteophytes. Our model detected the bicipital groove with a mean absolute error of less than 1mm on arthritic humeri, demonstrating a significant improvement over the previous gold standard approach. Successful identification of the bicipital groove with a high degree of accuracy even in arthritic humeri was accomplished. This model is open source and included in the python package shoulder.

Successful reconstruction of a bilateral comminuted mandibular fracture in a foal using 2.7 locking compression plates

SummaryA 23‐day‐old foal presented to the hospital with difficulty nursing and closing the mouth 2 days after sustaining a kick to the head. Computed tomography revealed a bilateral, complete, closed, comminuted fracture of the vertical ramus of the mandible. The fractures were repaired using open reduction and internal fixation with two 2.7 mm locking compression plates (LCPs) applied to the caudal and ventral aspects of each mandibular ramus. The surgery resulted in excellent fracture healing without any long‐term complications. Facial nerve paralysis was noted postoperatively but resolved within 14 days. The implants were removed after six and a half weeks, and the foal made a full recovery.

Controlled reconstruction and application research of lateral overlying strata structure in high-gas mines with thick-hard roofs for a fully-mechanized top-caving face

Due to the large mining area, the fully-mechanized top-caving mining with thick-hard roof is easy to form cantilever structure on the lateral roof of the working face, which on the one hand causes high stress level of adjacent roadway and serious deformation of roadway, on the other hand causes gas accumulation in corners, which brings severe challenges to safe and efficient mining of the mine. In this study, a mine facing such problems in Jincheng, China was taken as the research object. Based on the mechanical characteristics of coal and rock, the characteristics of overlying strata activity in the mining process of working face are mastered, and the dual effects of controlled transformation of lateral overlying strata structure on stress field and gas field were revealed. On this basis, roadway reinforcement and gas drainage schemes were put forward and applied. The results showed that the strength of the hard rock stratum was high in the triaxial stress environment, and it was not easily destroyed. However, once the strata exceed their strength threshold, they break down. In addition, the strength of coal is relatively low, and it is continuously deformed when the force exceeds its strength. The overlying strata structure after thick-hard roof fully-mechanized top-caving mining evolves in the following manner: “long cantilever length formed by the main roof being broken in the initial stage, voussoir beam formed by the upper hard roof being broken in the middle stage, and double cantilever beam formed by overlying strata compaction.” The stress carried by upper hard rock stratum is transferred to coal pillars, which is the main reason for the high stress environment of multi-purpose roadway with large coal pillars. The controlled transformation of lateral overlying strata structure by pre-splitting and roof cutting can realize the "transfer-unloading" of coal pillar stress and the "plugging and driving" of corner gas. Based on the hydraulic fracturing reconstruction of lateral overburden structure, the grouting reinforcement scheme of roadway and dynamic gas drainage scheme were put forward. The results demonstrated that after roof cutting, the maximum deformation of the surrounding rock in the multi-purpose roadway was reduced by approximately 90 %, and the maximum concentration of corner gas was decreased by 15.28 %. This approach successfully achieved a collaborative control effect on roadway surrounding rock stability and gas emission well within the safety limits.

Inflammatory tissue response in human soft tissue is caused by a higher particle load near carbon fiber-reinforced PEEK compared to titanium plates

Titanium as the leading implant material in locked plating is challenged by polymers such as carbon fiber-reinforced polyetheretherketone (CFR-PEEK), which became the focus of interest of researchers and manufacturers in recent years. However, data on human tissue response to these new implant materials are rare.Osteosynthesis plates and peri‑implant soft tissue samples of 16 healed proximal humerus fractures were examined (n = 8 CFR-PEEK, n = 8 titanium). Soft tissue was analyzed by immunohistochemistry and µCT. The entrapped foreign bodies were further examined for their material composition by FTIR. To gain insight into their origin and formation mechanism, explanted and new plates were evaluated by SEM, EDX, profilometry and HR-CT.In the peri‑implant soft tissue of the CFR-PEEK plates, an inflammatory tissue reaction was detected. Tissues contained foreign bodies, which could be identified as tantalum wires, carbon fiber fragments and PEEK particles. Titanium particles were also found in the peri‑implant soft tissue of the titanium plates but showed a less intense surrounding tissue inflammation in immunohistochemistry. The surface of explanted CFR-PEEK plates was rougher and showed exposed and broken carbon fibers as well as protruding and deformed tantalum wires, especially in used screw holes, whereas scratches were identified on the titanium plate surfaces.Particles were present in the peri‑implant soft tissue neighboring both implant materials and could be clearly assigned to the plate material. Particles from both plate materials caused detectable tissue inflammation, with more inflammatory cells found in soft tissue over CFR-PEEK plates than over titanium plates. Statement of significanceOsteosynthesis plates are ubiquitously used in various medical specialties for the reconstruction of bone fractures and defects and are therefore indispensable for trauma surgeons, ENT specialists and many others. The leading implant material are metals such as titanium, but recently implants made of polymers such as carbon fiber-reinforced polyetheretherketone (CFR-PEEK) have become increasingly popular. However, little is known about human tissue reaction and particle generation related to these new implant types. To clarify this question, 16 osteosynthesis plates (n = 8 titanium and n = 8 CFR-PEEK) and the overlying soft tissue were analyzed regarding particle occurrence and tissue inflammation. Tissue inflammation is clinically relevant for the development of scar tissue, which is discussed to cause movement restrictions and thus contributes significantly to patient outcome.

A coupled high-accuracy phase-field fluid–structure interaction framework for Stokes fluid-filled fracture surrounded by an elastic medium

In this work, we couple a high-accuracy phase-field fracture reconstruction approach iteratively to fluid–structure interaction. The key motivation is to utilise phase-field modelling to compute the fracture path. A mesh reconstruction allows a switch from interface-capturing to interface-tracking in which the coupling conditions can be realised in a highly accurate fashion. Consequently, inside the fracture, a Stokes flow can be modelled that is coupled to the surrounding elastic medium. A fully coupled approach is obtained by iterating between the phase-field and the fluid–structure interaction model. The resulting algorithm is demonstrated for several numerical examples of quasi-static brittle fractures. We consider both stationary and quasi-stationary problems. In the latter, the dynamics arise through an incrementally increasing given pressure.

Presurgical Virtual Planning and Intraoperative Navigation with 3D-Preformed Mesh: A New Protocol for Primary Orbital Fracture Reconstruction.

This pilot study aims to evaluate the feasibility and effectiveness of computer-assisted surgery protocol with 3D-preformed orbital titanium mesh (3D-POTM), using presurgical virtual planning and intraoperative navigation in primary inferomedial orbital fracture reconstruction. Between March 2021 and March 2023, perioperative data of patients undergoing surgery for unilateral inferomedial orbital fracture treated with 3D-POTM were analyzed. Presurgical virtual planning with a Standard Triangle Language file of preformed mesh was conducted using the mirrored unaffected contralateral side as a reference, and intraoperative navigation was used. The reconstruction accuracy was determined by: correspondence between postoperative reconstruction mesh position with presurgical virtual planning and difference among the reconstructed and the unaffected orbital volume. Pre- and postoperative diplopia and enophthalmos were assessed. Twenty-six patients were included. Isolated orbital floor fracture was reported in 14 (53.8%) patients, meanwhile medial wall and floor one in 12 (46.1%) cases. The mean difference between final plate position and ideal digital plan was 0.692 mm (95% CI: 0.601-0.783). The mean volume difference between reconstructed and unaffected orbit was 1.02 mL (95% CI: 0.451-1.589). Preoperative diplopia was settled out in all cases and enophthalmos in 19 (76.2%) of 21 patients. The proposed protocol is an adaptable and reliable workflow for the early treatment of inferomedial orbital fractures. It enables precise preoperative planning and intraoperative procedures, mitigating pitfalls and complications, and delivering excellent reconstruction, all while maintaining reasonable costs and commitment times.

The Continued Impact of Godina's Principles: Outcomes of Flap Coverage as a Function of Time After Definitive Fixation of Open Lower Extremity Fractures.

Early soft tissue coverage of open lower extremity fractures within 72 hours of injury leads to improved outcomes. Little is known about outcomes when definitive fixation is completed first. The purpose of this study is to quantify postoperative outcomes when soft tissue reconstruction is delayed until after definitive open reduction and internal fixation (ORIF) is completed. An insurance claims database was queried for all patients with open lower extremity fractures between 2010 and 2020 who underwent free or axial flap reconstruction after ORIF. This cohort was stratified into three groups: reconstruction performed 0 to 3, 3 to 7, and 7+ days after ORIF. The primary outcome was 90-day complication and reoperation rates. Bivariate and multivariable regression of all-cause complications and reoperations was evaluated for time to flap as a risk factor. A total of 863 patients with open lower extremity fractures underwent ORIF prior to flap soft tissue reconstruction. In total, 145 (16.8%), 162 (18.8%), and 556 (64.4%) patients underwent soft tissue reconstruction 0 to 3 days, 4 to 7 days, and 7+ days after ORIF, respectively. The 90-day complication rate of surgical site infections ( SSI; 16.6%, 16,7%, 28.8%; p = 0.001) and acute osteomyelitis (5.5%, 6.2%, 27.7%; p < 0.001) increased with delayed soft tissue reconstruction. Irrigation and debridement rates were directly related to time from ORIF to flap (33.8%, 51.9%, 61.9%; p < 0.001). Hardware removal rates were significantly higher with delayed treatment (10.3%, 9.3%, 39.3%; p < 0.001). The 0 to 3 day (odds ratio [OR] = 0.22; 95% confidence interval [CI]: 0.15, 0.32) and 4 to 7 day (OR = 0.26; 95% CI: 0.17, 0.40) groups showed protective factors against all-cause complications after bivariate and multivariate regression. Early soft tissue reconstruction of open lower extremity fractures performed within 7 days of ORIF reduces complication rates and reduces the variability of complication rates including SSIs, acute osteomyelitis, and hardware failure.

Bone flap binding and transposition: a method for bone reconstruction in cranial burst fractures and early-stage growing skull fractures.

To introduce a method of cranial bone reconstruction for cranial burst fractures and early-stage growing skull fractures, named bone flap binding and transposition. Cranial burst fractures, severe head injuries predominantly observed in infants, are characterized by widely diastatic skull fractures coupled with acute extracranial cerebral herniation beneath an intact scalp through ruptured dura mater. These injuries can develop into growing skull fractures. This study included two cases to illustrate the procedure, with a particular focus on the bone steps in managing these conditions. The medical history, clinical presentation, surgical procedures, and postoperative follow-up were retrospectively studied. The details of the surgical procedure were described. The method of bone reconstruction, named bone flap binding and transposition, was applied after the lacerated dural repair. Two bone pieces were combined to eliminate the diastatic bone defect and then fixed by an absorbable cranial fixation clip and bound by sutures. The combined bone flap was repositioned into the bone window, completely covering the area of the original dural laceration. Subsequently, the bone defect was transferred to the area of normal dura. The postoperative courses for the two infants were uneventful. Follow-up CT scans revealed new bone formation at the previous bone defect and no progressive growing skull fracture. The major cranial defects had disappeared, leaving only small residual defects at the corners of the skull bone window, which required further recovery and did not affect the solidity of the skull. Bone flap binding and transposition provide a straightforward, cost-effective, and reliable method for cranial bone reconstruction of cranial burst fractures and early-stage growing skull fractures. This method has taken full advantage of the small infant's dura osteogenic potential without the need for artificial or metallic bone repair materials. The effectiveness of the method needs further validation with more cases in the future.

Reconstruction of Orbital Wall Fractures with a Combination of Resorbable Plates and Antibiotic-Impregnated Collagen Sheets.

(1) Background: Orbital wall fractures are common in maxillofacial trauma, and artificial implants are often used for reconstruction. However, there has always been concern about infection because implants are directly exposed to the airway. This study was conducted to determine the effectiveness of a combination of resorbable plates and antibiotic-impregnated collagen sheets in reconstructions of orbital fractures and to determine whether it had an effect in reducing postoperative antibiotic use. (2) Methods: The retrospective study was conducted on 195 patients who underwent orbital wall reconstruction from March 2019 to August 2022. The 176 patients in the control group underwent reconstruction using only resorbable plates and were administered postoperative antibiotics for 5 to 7 days. On the other hand, the 19 patients in the experimental group underwent reconstruction using a combination of resorbable plates and antibiotic-impregnated collagen sheets and only received antibiotics once before surgery. The occurrence of ocular complications, the length of hospitalization, the infection incidence rate, and the adverse effects of antibiotics were investigated. (3) Results: significant ocular complications were observed in the experimental group during a follow-up period of more than 1 year. Regarding postoperative infections, there were two cases of infection in the control group (infection rate: 1.14%), while no infection was found in the experimental group. The hospitalization period of the experimental group was significantly shorter than that of the control group (p < 0.01), and the incidence of total adverse effects of antibiotics, especially nausea, was lower in the experimental group (p = 0.02). (4) Conclusions: The combined use of resorbable plates and antibiotic-impregnated collagen sheets allows effective orbital wall reconstruction without infection, with a shorter hospital stay, and with fewer antibiotic adverse effects.

Outcomes Following Pedestal Cup Reconstruction of (Impending) Pathological Fractures of the Acetabulum due to Metastatic Bone Disease.

The online version contains supplementary material available at 10.1007/s13193-024-01917-x.

Reconstruction of depressed skull fracture in school patients. Technique description

Reconstruction of depressed skull fracture in school patients. Technique description

Surgical outcomes of anterior column reconstruction for spinal fractures caused by minor trauma-preoperative examination of the number of intervertebral bone bridges is key to obtaining good bone fusion-

BackgroundTo achieve good bone fusion in anterior column reconstruction for vertebral fractures, not only bone mineral density (BMD) and bone metabolism markers but also lever arms due to bone bridging between vertebral bodies should be evaluated. However, until now, no lever arm index has been devised. Therefore, we believe that the maximum number of vertebral bodies that are bony and cross-linked with the contiguous adjacent vertebrae (maxVB) can be used as a measure for lever arms. The purpose of this study is to investigate the surgical outcomes of anterior column reconstruction for spinal fractures and to determine the effect of bone bridging between vertebral bodies on the rate of bone fusion using the maxVB as an indicator of the length of the lever arm.MethodsThe clinical data of 81 patients who underwent anterior column reconstruction for spinal fracture between 2014 and 2022 were evaluated. The bone fusion rate, back pain score, between the maxVB = 0 and the maxVB ≥ 2 patients were adjusted for confounding factors (age, smoking history, diabetes mellitus history, BMD, osteoporosis drugs, surgical technique, number of fixed vertebrae, materials used for the anterior props, etc.) and analysed with multivariate or multiple regression analyses. The bone healing rate and incidence of postoperative back pain were compared among the three groups (maxVB = 0, 2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\leqq$$\\end{document}maxVB\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\leqq$$\\end{document}8, maxVB ≧ 9) and divided by the maxVB after adjusting for confounding factors.ResultsPatients with a maxVB ≥ 2 had a significantly higher bone fusion rate (p < 0.01) and postoperative back pain score (p < 0.01) than those with a maxVB = 0. Among the three groups, the bone fusion rate and back pain score were significantly higher in the 2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\leqq$$\\end{document}maxVB\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\leqq$$\\end{document}8 group (p = 0.01, p < 0.01).ConclusionsExamination of the maxVB as an indicator of the use of a lever arm is beneficial for anterior column reconstruction for vertebral fractures. Patients with no intervertebral bone bridging or a high number of bone bridges are in more need of measures to promote bone fusion than patients with a moderate number of bone bridges are.

A retrospective study of occlusal reconstruction in patients with old jaw fractures and dentition defects

PurposeThis study evaluated the methods and clinical effects of multidisciplinary collaborative treatment for occlusal reconstruction in patients with old jaw fractures and dentition defects. MethodsPatients with old jaw fractures and dentition defects who underwent occlusal reconstruction at the Third Affiliated Hospital of Air Force Military Medical University from January 2018 to December 2022 were enrolled. Clinical treatment was classified into 3 phases. In phase I, techniques such as orthognathic surgery, microsurgery, and distraction osteogenesis were employed to reconstruct the correct 3-dimensional (3D) jaw position relationship. In phase II, bone augmentation and soft tissue management techniques were utilized to address insufficient alveolar bone mass and poor gingival soft tissue conditions. In phase III, implant-supported overdentures or fixed dentures were used for occlusal reconstruction. A summary of treatment methods, clinical efficacy evaluation, comparative analysis of imageological examinations, and satisfaction questionnaire survey were utilized to evaluate the therapeutic efficacy in patients with traumatic old jaw fractures and dentition defects. All data are summarized using the arithmetic mean ± standard deviation and compared using independent sample t-tests. ResultsIn 15 patients with old jaw fractures and dentition defects (an average age of 32 years, ranging from 18 to 53 years), there were 7 cases of malocclusion of single maxillary fracture, 6 of malocclusion of single mandible fracture, and 2 of malocclusion of both maxillary and mandible fractures. There were 5 patients with single maxillary dentition defects, 2 with single mandibular dentition defects, and 8 with both maxillary and mandibular dentition defects. To reconstruct the correct 3D jaw positional relationship, 5 patients underwent Le Fort I osteotomy of the maxilla, 3 underwent bilateral sagittal split ramus osteotomy of the mandible, 4 underwent open reduction and internal fixation for old jaw fractures, 3 underwent temporomandibular joint surgery, and 4 underwent distraction osteogenesis. All patients underwent jawbone augmentation, of whom 4 patients underwent a free composite vascularized bone flap (26.66%) and the remaining patients underwent local alveolar bone augmentation. Free gingival graft and connective tissue graft were the main methods for soft tissue augmentation (73.33%).The 15 patients received 81 implants, of whom 11 patients received implant-supported fixed dentures and 4 received implant-supported removable dentures. The survival rate of all implants was 93.82%. The final imageological examination of 15 patients confirmed that the malocclusion was corrected, and the clinical treatment ultimately achieved occlusal function reconstruction. The patient satisfaction questionnaire survey showed that they were satisfied with the efficacy, phonetics, aesthetics, and comfort after treatment. ConclusionOcclusal reconstruction of old jaw fractures and dentition defects requires a phased sequential comprehensive treatment, consisting of 3D spatial jaw correction, alveolar bone augmentation and soft tissue augmentation, and implant-supported occlusal reconstruction, achieving satisfactory clinical therapeutic efficacy.

Techniques and results of reconstruction of femoral head fractures: An Update

A narrative review of the literature was conducted to examine the data on femoral head fractures, with a particular focus on their management, complications and clinical outcomes.A PRISMA strategy was used. Medline and Scopus library databases were queried using pre-defined MeSH terms and Boolean operators. Quality of evidence was evaluated based on OCEBM and GRADE systems. The 50 eligible articles that met the predefined inclusion criteria reported on 1403 femoral head fractures. A detailed analysis of the surgical approaches used was performed in 38 articles with 856 fractures.Most fractures were treated surgically (90,8 %) with preferred anatomical reconstruction in 76,7 % of all operatively treated cases. Posterior approaches were the most common (52.5 %). This was evenly split between surgical hip dislocation and the classic Kocher-Langenbeck approach. 70.5 % of surgically treated cases achieved excellent or good result according to Thompson-Epstein criteria. Highest rate of excellent results showed minimal invasive osteosynthesis and surgical hip dislocation. Major late complications were avascular necrosis (10.8 %), post-traumatic arthritis (16.2 %) and heterotopic ossification (20.8 %). Secondary THA was necessary in 6.9 %. Highest rate of major complications was joined with anterior approach (77 %), lowest rate from frequently used approaches surgical hip dislocation (37.8 %).Conservative treatment recedes into the background. The Ganz flip osteotomy with surgical hip dislocation allows safe treatment of all types of fractures and should be considered the first choice, offering the lowest rate of complications and one of the best functional outcomes. Reconstruction of Pipkin Type III fractures should be reserved for very young patients due to high rate of major complications.

Research on the data-driven inter-well fracture channeling identification method for shale gas reservoirs

The issue of inter-well fracture channeling in shale reservoirs is becoming increasingly prominent, significantly impacting the production of nearby wells. Therefore, it is crucial to accurately determine the location of fracture channeling in order to effectively design anti-channeling measures and optimize reservoir fracturing. In this paper, a data-driven fracture propagation model and fracture channeling identification method are established. In the model, the fracture morphology is fitted by the bottom-hole flowing pressure constraint. The bottom-hole flowing pressure (pwp) calculated by the construction pump pressure and the fluid wellbore flow is mainly considered as the real solution. The bottom-hole flowing pressure (pwf) calculated by the construction displacement and the fracture morphology is used as the constraint variable, and the fracture parameters are changed using the SPSA optimization algorithm to realize the dynamic fitting of the fracture morphology. In order to accurately describe the position of fracture channeling, the seepage radius of the fracture boundary is introduced to calculate the volume of fracture reconstruction. The volume coefficient of repeated reconstruction is used as the quantitative evaluation index of fracture channeling. This approach enables an accurate depiction of the position of fracture channeling. Finally, the model method is applied to the actual fracture channeling well. The study shows that the fracture length of the well inversion is greater than the well spacing, and there is a possibility of inter-well fracture channeling. The volume coefficient of repeated reconstruction is 8%, similar to the critical fracture channeling index. There are nine fracturing sections with fracture channeling, and the maximum fracture channeling coefficient is 14.2%. This paper successfully explains the reason for cross-well fracture channeling, and its conclusion aligns with the actual monitoring results. The proposed method in this paper effectively identifies the location of fracture channeling and offers guidance for optimizing channeling prevention in subsequent designs.

RECONSTRUCTION OF ORBITAL FLOOR FRACTURES USING SILICONE BLOCK IMPLANT

Abstract&#x0D; Introduction &amp; Objectives : It has long been a controversial-both the materials for orbital floor reconstruction and the timing of surgery. Silicone block implant is affordable and readily available especially in developing countries. Due to its complications and the development of other materials, silicone block implant has rarely been used. This study aims to evaluate the outcomes of timing of surgery and the use of silicone block implant in orbital floor fractures reconstruction.&#x0D; Methods : We conducted a retrospective review of patients who had orbital floor fractures and undergone reconstruction surgery using silicone block implant in Cipto Mangunkusumo Hospital from January 2017 to December 2021. These patients then divided into three groups based on their surgery interval time. Outpatient notes, Computed Tomography (CT) reports, surgical admission notes, records and complications were recorded. Patients with follow-up less than three months were excluded.&#x0D; Results : Thirty-one patients were included (23 males, 8 females) with age 18-60 years old being dominant. Thirty (96.8%) patients had unilateral fractures, 23 patients (74.2%) came with impure fractures, and fractures mostly caused by traffic accidents (83.9%). Subconjunctival bleeding and eyelid abnormalities were found as the majority of ocular involvement. Symptoms with the greatest improvement were different between three groups based on surgery interval time. Besides, only one extruded implant was found.&#x0D; Conclusion : Silicone block implant provides good outcomes with minimal complications even after late surgical repair of orbital floor fractures.