Fracture Sets Research Articles

Kinematics, intensity, and spatial arrangement of extensional fractures in the Tuxtla-Malpaso fault system: Chiapas strike-slip fault province, southern Mexico

We describe the orientation, number, size, distribution, and fracture spatial arrangement in the central part of the kilometric Tuxtla-Malpaso fault system, one of the largest in the south of Mexico which cuts Cretaceous calcareous rocks. In this area, there are two sub-vertical extensional fracture sets (T1 and T2). The T1 fractures have ∼ N–S orientation and recorded 4.48 % of extension. The T2 fractures cut the T1 fractures, have NE-SW orientation, and accommodate an amount of extension of 3.87 %. These two fracture sets are parallel to two normal fault groups. The youngest normal faults (F2) have NE-SW strike and cut the N–S normal faults (F1). The F1 faults record a reactivation as strike-slip faults contemporaneous with F2.The T1 and T2 fractures have a fracture intensity between 9.08 and 9.39 (P10) on mesoscopic scale. In the case of the spacing, the value of this parameter (0.28–1) is related to fracture clustering. This behavior agrees with the values of fractal box dimension (0.72–0.81), correlation dimension (0.24–0.6), Lyapunov exponent (1.31–2.42), and coefficient of variation (0.94–1.85) on mesoscopic scale. The cumulative aperture vs. distance shows that T1 and T2 fractures have heterogeneous strain distribution. The fracture spatial arrangement is verified with the normalized correlation count analysis (NCC). The NCC graphs show a clustering behavior for T1 and T2 fractures, which are related to a regulary-spaced fractal clusters pattern. We suggest that this pattern is related to the mechanical stratigraphy and the strain location in the fault zones, while the fracture intensity depends on the degree of fracture clustering and rock type more than the amount of strain.Finally, the T1 fractures were associated with the right strike-slip kinematic for the NW-SE Tuxtla-Malpaso fault. This activity recorded a transtension behavior during the middle Miocene. The T2 fractures were formed during the reactivation (Pliocene) of the Tuxtla-Malpaso fault as the left strike-slip fault behind wrenching-transpression kinematics.

Development characteristic and main controlling factors of the Ordovician karst caves in the Keping area, Tarim Basin

This research endeavors to characterize the primary factors that influence the formation of Ordovician karst caves in the Keping area of China. A 3D digital model of the cave structure and fracture sets was generated using an Unmanned Aerial Vehicle (UAV). The characterization of fracture and cavity development involved the examination of thin sections, fluid inclusion testing, and the analysis of C and O isotopes. Key parameters controlling karst development were identified through the application of multiple linear regressions and statistical analysis. The Ordovician limestone karst cave exhibited four distinct fracture sets. Set 1 consisted of partially filled fractures with a sub-horizontal orientation and a striking direction of SEE, interpreted to have formed during the Middle-Late Caledonian orogeny. Set 2 comprised inclined tensile-shear fractures with a striking direction of NEE, likely formed during the Early Hercynian orogeny. Set 3 included fully filled conjugate shear fractures with variable orientations, which developed during the Indo-Yanshanian orogeny. Set 4 comprised high-angle shear fractures with striking directions of NNE 20–40° and NEE 60–80°, formed during the Himalayan orogeny. Two stages of cave filling deposition were identified. Stage I coincided with the Middle-Late Caledonian Set 1 fractures and can be attributed to the circulation of freshwater fluid. Stage II occurred concurrently with the Early Hercynian Set 2 fractures and can be attributed to deep hydrothermal fluid circulation. The karst caves are interconnected and aligned along a fault zone. The Ordovician limestone possesses high permeability, which facilitates karst development. The lithologies in the Aksu area play a crucial role in cavity formation and dissolution. The development of cavities is influenced by the combined patterns of the fracture system, with larger fault and fracture zones resulting in larger cave sizes. As one moves away from the fault zone, limestone dissolution decreases, resulting in less pronounced karst development.

Fixation of 3-Part Intra Articular Distal Radius Fracture with Combined Volar Plate and Dorsal Spanning Plate: A Case Report

Introduction: The aim of this study is to illustrate a case in which the use of a dorsal spanning plate followed by volar plating may be indicated in the setting of a complex intra-articular distal radius fracture. Combined dorsal spanning plate and volar plating is a rare procedure reserved typically for comminuted fractures of the distal radius. This case highlights the first reported incidence in which a dorsal spanning plate of a distal radius fracture resulted in the volar displacement of the fragments, requiring subsequent volar plating. In the end, the outcome was favorable, as the follow-up imaging displayed good bone healing and union with minimal complications. Case Report: A 52-year-old male presented to the ED at our institution following a traumatic fall onto his left upper extremity. Radiographic imaging revealed fractures at the midshaft of the humerus as well as a very distal three-part intra-articular radius fracture. Due to the nature of the patient’s distal radius fracture, initial fixation with a dorsal spanning plate was planned. However, follow-up imaging 3 weeks postoperatively revealed volar displacement of his fracture, so the patient underwent open reduction internal fixation with a volar distal radius plate. Follow-up over the next few months displayed a union of the fracture fragments and the dorsal spanning plate was removed 4 months postoperatively with imaging showing no complications. Conclusion: We present this case to highlight the complication of volar displacement that may follow initial dorsal spanning plate fixation of a three-part intra-articular distal radius fracture that can be resolved with the addition of a volar plate, as well as possible indications for combined dorsal spanning plate and volar plate fixation of complex distal radius fractures at the time of initial fixation. Keywords: Distal radius, volar plate, spanning plate, fracture, comminution, intra-articular fracture.

Techniques to Remove Press-Fit Osseointegration Implants.

Techniques to Remove Press-Fit Osseointegration Implants.

A Case Report of Trauma-induced Coagulopathy in the Setting of an Isolated Humeral Shaft Fracture

Introduction: Humeral shaft fractures are common orthopedic injuries often resulting from high-energy trauma in young patients and low-energy trauma in the elderly. Non-operative management has traditionally been the mainstay of treatment for isolated and low-energy humeral shaft fractures, with operative management reserved for severe cases often involving neurovascular compromise. This case describes a rare, yet catastrophic complication of a humeral shaft fracture where the patient developed trauma-induced coagulopathy (TIC), resulting in amputation of the affected extremity, systemic inflammatory response syndrome (SIRS), and ultimately death. Case Report: A 60-year-old female patient with an isolated left humeral shaft fracture was originally treated with closed reduction and splinting. The patient returned 6 days later with a dysvascular left upper extremity and subsequently decompensated over the next 2 weeks secondary to TIC and SIRS. This resulted in a left transhumeral amputation, dysvascular right upper extremity, multiorgan failure, and ultimately death. Conclusion: This report serves as a unique clinical example of rapid decompensation related to TIC and SIRS in the setting of a humeral shaft fracture. Managing orthopedic teams must be aware of these rare sequelae of humeral shaft fracture and be prepared to respond rapidly with surgical intervention and consultation of additional services to limit associated morbidity and mortality. Keywords: Dysvascular limb, systemic inflammatory response syndrome, trauma-induced coagulopathy, fracture, thrombosis.

Exhumation mechanisms of the Himalayan metamorphic core in the Bhagirathi Valley, NW India: Insights from an integrated structural and metamorphic analysis

The Himalayan metamorphic core in the Bhagirathi valley (NW India) consists of low-grade rocks belonging to the Lesser Himalayan Sequence to the south, and of high-grade rocks of the Greater Himalayan Sequence (GHS), to the north. The contact between these two units is a 2–3 km thick high-strain zone known as the Main Central Thrust zone (MCTz). Structural studies in the GHS identify the superposition of foliation (S2) related to tight isoclinal fold (F2) on a pre-existing foliation (S1). S2 was further overprinted by D3 crenulations, and a set of conjugate fractures (D4) overprinted these ductile fabrics. Deformation in the GHS was characterized by top-to-the-SW shearing, which, in its upper structural level, was overprinted by top-to-the-NE extensional shear. Metamorphic analysis shows a moderate T/high P inverted metamorphic sequence with pre-to syn-kinematic, inclusion-rich garnet in the structurally lower part of the GHS and high T-moderate P prograde metamorphism with post-tectonic inclusion-free garnet and evidence of partial melting, in its upper structural level. We envisage that the uppermost part of the GHS and the lower part of the GHS, including the MCTz, are two distinct tectonic slices, separated by a tectono-metamorphic discontinuity.

Experimental study of decompression wave characteristics and steel pipe applicability of supercritical CO2 pipeline

High-strength pipeline steel is the optimal choice for continuously transporting large amounts of carbon dioxide (CO2) in the future Carbon capture, utilization and storage (CCUS) industrial chain, and supercritical CO2 (S–CO2) is the ideal phase state from an emitter to an onshore storage site. In CCUS projects, it is very indispensable to carry out the suitability of high steel-grade pipelines to ensure the safe operation of pipelines. It is considered a catastrophic incident for creatures and equipment once pipeline failure when fractures or propagation occurs. In this paper, the fracture propagation velocity of X70, X80, and X90 pipeline materials is calculated base on the high strength line pipe (HLP). Meanwhile, three sets of full-bore fracture (FBR) experiments of S–CO2 pipelines were conducted with similar initial status on an industrial-scale setup, and the decompression wave velocity was obtained with the data acquisition system. The result shows that the initial decompression wave velocity of S–CO2 is about 270 m/s, and the pressure plateau is between 6.8 and 7.3 MPa, corresponding to the decompression wave velocity, which is about in the range of 100–220 m/s. After that, the decompression wave velocity prediction model was established based on the homogeneous equilibrium method (HEM) and the equation of state (Eos), and the prediction results are more conservative than the experimental results. To ensure that the pipeline will not ductilely fracture in the event of a leakage or rupture, X70, X80 and X90 grade steel pipeline design wall thickness and minimum arrest toughness values are determined based on the two-curve method (TCM), respectively. Furthermore, a CO2 pipeline design model is developed based on the experimental data and decompression wave calculation method. The significant experimental data could be used for safety assessment and theoretical model validation in the CO2 transport pipeline and is useful in developing better fracture control models.

Identifying the fracture characteristics that control deformation localization and catastrophic failure in fluid-saturated crystalline rocks in upper crustal conditions

Previous studies show that the total volume of fractures increases non-linearly during loading as rocks approach failure in triaxial compression at stress and temperature conditions representative of the upper crust. However, the factors that control the critical volume of fractures or the critical spatial organization of the fracture network that trigger macroscopic failure remain unclear. To identify the fracture characteristics that determine the timing of macroscopic failure and localization of the fracture networks, we analyze data from six X-ray tomography experiments on Westerly granite with varying confining stress, fluid pressure, and amounts of preexisting damage. We develop machine learning models to predict 1) the timing of failure, 2) the localization of the fracture networks as measured with the Gini coefficient of the fracture volume, and 3) the change in localization from one differential stress step to the next. When the models only have access to individual fracture characteristics, the fracture length produces the best predictions of the distance to failure. When the models have access to the fracture length and sets of other characteristics, the fracture volume, aperture, and distance between fractures produce the best predictions of the distance to failure. The characteristics that describe the time or loading in the experiment, the axial strain and differential stress, produce some of the best predictions of the Gini coefficient. The results are generally consistent among the different experiments, suggesting that the fracture characteristics that determine the timing of macroscopic failure, and the localization of the fracture network, are independent of the range of confining stress, fluid pressure, and amount of preexisting damage tested here. Our results are consistent with the idea that monitoring the spatial distribution of deformation and changes in the seismic wave properties indicative of fracture growth may improve forecasting efforts of failure in the crust.

Treatment of 2-part, 3-part, and 4-part proximal humerus fractures from 2016 to 2020: A nationally-representative database

IntroductionComplex proximal humerus fractures pose challenges in elderly patients, as this common scenario can lead to unpredictable outcomes, regardless of treatment method. Given the evolving nature of the treatment for 3-and-4-part proximal humerus fractures, an epidemiological analysis offers a way to minimize the gap between appropriate understanding and effective intervention. As such, we aimed to i) evaluate the trends of nonoperative and operative management; and ii) compare the complication rates of ORIF to conversion ORIF (to RTSA). MethodsWe utilized a national, all-payer database to include patients who underwent open reduction and internal fixation for 2-part (n = 2783), 3-part (n = 2170), 4-part (n = 1087) proximal humerus fractures between April 2016 to December 2022. Patients who failed ORIF to RTSA included n = 108 for 2-part fractures, n = 123 for 3-part fractures, and n = 128 for 4-part fractures. We collected demographic and postoperative medical and surgical complications at 90-days, in addition to time-interval between ORIF and RTSA. ResultsThe malunion and nonunion rates for ORIF between different types of proximal humerus fractures were similar (2-part fractures: 1.8 %, 4.7 %; 3-part fractures: 1.8 %, 3.5 %; 4-part fractures: 2.4 %, 3.7 %). The conversion rates of failed ORIF to RTSA were 1.9 %, 2.8 %, and 5.9 % for 2-part, 3-part, and 4-part fractures, respectively. The time interval from failed ORIF to RTSA was 190 days for 2-part fractures, 169 days for 3-part fractures, and 129 for 4-part fractures. ConclusionAn epidemiological analysis of proximal humerus fractures by fracture type demonstrated an increase in RTSA for 2-part, 3-part, and 4-part fractures while nonoperative treatment showed no change from 2016 to 2020. Additional research is needed to determine which fractures are best treated operatively while maximizing outcomes. In the setting of complex proximal humerus fractures, several options seem feasible depending on patient demographic characteristics.

Fracture distribution along open folds in southern Tunisia: implications for naturally fractured reservoirs

Fracture networks play a critical role in fluid flow within reservoirs, and it is therefore important to understand the interactions and influences of these networks. Our study focuses on the Southern Chotts–Jeffara Basin, which hosts reservoirs within Triassic, Permian and Ordovician units containing significant hydrocarbon accumulations. Recent developments on the structural understanding of the basin have proved that a regional shortening phase occurred between the Permian and Jurassic, forming open folds and a distributed fracture network. Analysis of late Paleozoic and Mesozoic outcrops within the basin has identified several sets of fractures (with dip directions and dip angles of 150/80 and 212/86) and compressional structural features that support this shortening hypothesis. We have integrated fracture data from surface analogues and subsurface analysis of advanced seismic attributes and well data through structural linking to form a 2D hybrid fracture model of the reservoirs in the region. Through analytical aperture modelling and numerical simulation, we found that the fractures orientated 212° in combination with large-scale fractures contribute significantly to the fluid-flow orientation and potential reservoir permeability. Our presented fracture workflow and framework provide an insight into network characterization within naturally fractured reservoirs of Tunisia, and how certain structures form fluid pathways that influence flow and production. Supplementary material: Data and figures detailing fracture characterisation and modelling along open folds in southern Tunisia are available at https://doi.org/10.6084/m9.figshare.c.6904499

Fracturing parameter optimization technology for highly deviated wells in complex lithologic reservoirs

Highly-deviated wells are the key technology to reduce the risk of drilling accidents and improve the utilization of reservoirs. However, for reservoirs with complex lithology, highly-deviated wells are faced with the problems of geomechanical transformation and fracturing parameter optimization. The research on fracturing parameter optimization technology of high-deviated wells in complex lithologic reservoirs is helpful to the research and application of geomechanics in deep unconventional reservoirs. This paper is based on geological mechanics laboratory experiments and logging interpretation, combined with regional geological background, to clarify the geological and mechanical characteristics of the Fengcheng Formation shale oil region in the Mabei Slope. On this basis, based on the current geostress field and natural fracture distribution pattern of the Mabei Slope, an integrated model of shale oil geological engineering in local well areas was established. Based on the finite element method, optimization design was carried out for the cluster spacing, construction fluid volume, displacement, and sand volume of highly deviated well fracturing, and three-dimensional simulation of fracturing fractures was completed. The research results indicate that: (1) The current dominant direction of the maximum principal stress in the Fengcheng Formation on the Mabei Slope is from northeast to southwest, with the maximum horizontal principal stress generally ranging from 90 to 120 MPa and the minimum horizontal principal stress generally ranging from 70 to 110 MPa. (2) The difference in stress between the two horizontal directions is relatively large, generally greater than 8 MPa. Two sets of natural fractures have developed in the research area, one with a northwest southeast trend and the other with a northeast southwest trend. The natural fracture density of the Fengcheng Formation shale reservoir in the Mabei Slope is 0.32–1.12/m, with an average of 0.58/m, indicating a moderate to high degree of fracture development. (3) The geological model and three-dimensional geo-mechanical model are established according to the actual drilling geological data, and different schemes are designed to carry out single parameter optimization. The optimization results show that the optimal cluster spacing of the subdividing cutting volume pressure of the highly deviated wells in the Fengcheng Formation of the Mabei Slope is 12 m, the optimal construction fluid volume is 1400–1600 m3/section, the optimal construction displacement is 8 m3/min, and the optimal sanding strength is 2.5 m3/m. At the same time, by comparing the fracturing implementation effect with the fracturing scheme design, it is proven that the artificial parameter optimization method for highly deviated wells based on the finite element method based on the regional stress background and the natural fracture development law proposed in this paper is feasible and can provide a scientific basis for the fracturing development of highly deviated wells in complex lithologic reservoirs. This research has been well applied in Mahu area of Xinjiang oilfield.

Utility of CT or X-ray in the management of adult nasal fracture

PurposeThe primary objective of this study is to evaluate the use of imaging in the management of nasal fracture in adults and determine if imaging is beneficial to clinical decision making when planning for surgery. A secondary objective of this study is to compare surgical rates for nasal fracture between pediatric and adult populations. MethodsThis is a retrospective case-control study of 357 patients seen at University Hospitals Cleveland Medical Center from January 2015 through January 2020 with a diagnosis of nasal fracture. An odds ratio was calculated to determine likelihood of surgical intervention between patients who had imaging of the nasal bones and patients who did not. Results82 % of patients had either CT or X-ray imaging. The odds ratio of patients who had surgery after CT or X-ray imaging compared to patients who had surgery without prior imaging was 0.092 (95 % CI: 0.0448–0.1898, p-value <0.0001). A total of 54 (15 %) adult patients had surgery, in comparison to 50 % of pediatric patients with diagnosis of nasal fracture. 202 (57 %) of patients did not follow up after initial diagnosis by radiology. ConclusionThe statistical analysis suggests that while CT and X-ray are frequently obtained in the setting of nasal fracture, patients without imaging are more likely to have surgery (p < 0.05) than patients with imaging. This indicates that imaging is likely unnecessary for surgical planning. Most adults do not pursue surgery, and surgical rates for adults with nasal fracture are much lower than those of pediatric patients with nasal fracture.

Olivine microstructure and thermometry in olivine‐phyric shergottites Sayh al Uhaymir 005 and Dar al Gani 476

AbstractOlivine‐phyric shergottites are relatively young Martian meteorites that resemble primitive mantle‐derived melts, so offer insight into the causes of recent magmatism on Mars. The Al‐in‐olivine geothermometer offers the potential to examine (near‐)liquidus melt temperatures. However, the ubiquitous shock features in most Martian meteorites, caused by high‐energy impacts, can change the structure and composition of olivine crystals, making the applicability of mineral geothermometry methods uncertain. This study examines microstructure and mineral chemistry in two shocked primitive, depleted olivine‐phyric shergottites, Sayh al Uhaymir (SaU) 005 and Dar al Gani (DaG) 476. DaG 476 is unsuitable for Al‐in‐olivine thermometry because of the presence of difficult‐to‐observe but pervasive networks of undulating veins in olivine down to sub‐micron sizes, caused by melting and providing pathways for cation diffusion. In contrast, SaU 005 can be used for Al‐in‐olivine thermometry despite the presence of conjugate shear and fracture sets and micron‐scale cpx‐spinel exsolution. The average crystallization temperature of Fo&gt;70 olivine in SaU 005, 1380°C, is near‐identical to the average temperature of new and published Fo&gt;70 data from all olivine‐phyric shergottites. When corrected for equilibrium with mantle olivine (Fo80) this corresponds to a mantle temperature of approximately 1500°C, 130°C hotter than ambient Martian mantle when shergottites formed. Shergottites were generated by melting within a moderately hot mantle plume or thermal anomaly, in support of other evidence that the Martian mantle is actively convecting. However, it does not support the extremely high potential temperatures estimated for the shergottite source by a whole‐rock petrological method.

Isolated pure motor apraxia in the setting of depressed skull fracture: A case report and review of the literature

Introduction: An isolated pure apraxia of speech following head trauma is a rare clinical presentation in the absence of any other neurologic deficit. It is more commonly seen in patients with vascular pathology. Confusion can exist in recognizing an apraxia of speech versus a true Broca’s aphasia. We report such a case in a patient undergoing significant head trauma. The pathology and its management are discussed. Case Report: A 41-year-old male presented to our Emergency Department with a 3 cm laceration to the left side of the head following an assault with an unknown object. The patient suffered a depressed skull fracture with underlying epidural hematoma, bilateral traumatic subarachnoid hemorrhages, and a resultant isolated pure motor apraxia of speech. He was treated effectively with an emergency frontoparietal craniotomy, elevation and repair of his skull fracture, and evacuation of his epidural hematoma. His pure motor apraxia was greatly improved post-operatively and the patient was referred to outpatient speech therapy with continued neurosurgical follow-up. Conclusion: This case represents the unusual presentation of a pure motor apraxia of speech following traumatic assault to the left frontoparietal skull. An excellent therapeutic response was obtained following surgical intervention and speech therapy.

Fracture Network Analysis of Karstified Subis Limestone Build-Up in Niah, Sarawak

Understanding complex carbonate fracture networks and karstification at various geological scales is challenging, especially with limited multi-scale datasets. This paper aims to reduce uncertainty in the fracture architecture of Central Luconia karstified reservoirs by narrowing observational gaps between seismic and well data by using the discrete fracture models of exposed limestone outcrops as analogues for the subsurface carbonate reservoir. An outcrop-based fracture network characterisation of a near-surface paleo-karst at Subis Limestone combined with lineament analysis was conducted to extract fracture parameters. The karst structure was first delineated using a digital elevation map and outcrop examination. Then, topology analysis was performed, following the creation of two-dimensional discrete fracture models. Two main fracture sets oriented northeast–southwest and northwest–southeast and 79 potential dolines were identified. Fracture intersections, northeast–southwest major orientations, and drainage systems highly influenced the karst features. The Subis Limestone fracture model revealed that the highest number of fractures and total length of fractures were concentrated in the northern part of the Subis Limestone build-up (X: 250–350, Y: 150–250) and became denser towards the northwest direction of the outcrop (X: 600–800). The fractures in the Subis paleo-karsts appear isolated, with I-nodes ranging from 0.74 to 0.94. Hence, it is crucial to incorporate matrix porosity into multiple scales of fracture network modelling to improve upscaling and the modelling of fracture–vug networks, as well as to minimise the underestimation of discrete fracture networks in fractured and karstified limestone.

Fracturing timing of Jurassic reservoirs in the Dibei-Tuziluoke gas field, Kuqa foreland basin: Evidence from petrography, fluid inclusions, and clumped isotopes

Determining the timing of fracturing is crucial for understanding reservoir evolution and hydrocarbon accumulation in foreland basins. Using fracturing data from cores, borehole images, and outcrops, combined with the clumped isotope (Δ47) and fluid inclusion analyses of carbonate minerals filled in pores and fractures, this study ascertained the fracturing timing of the Jurassic reservoirs in the Dibei-Tuziluoke Gas Field, Kuqa Foreland Basin. Data from outcrops and borehole images show two dominant fracture sets in the study area: W-E and NE-SW striking fractures. Some W-E striking fractures are carbonate-filled, while NE-SW striking fractures lack mineral fillings. Bitumen veins, not easy to be identified in borehole images, are prevalent in cores. The petrographic analysis reveals that these bitumen veins formed before the calcite cementation in pores and display high viscosity and low maturity. Homogenization temperatures (Th) from primary fluid inclusion assemblages in two representative calcite vein samples were notably lower than TΔ47 values from corresponding samples. This suggests the Δ47 signature underwent alteration due to partial reordering during burial. Thus, Δ47-derived temperatures (apparent temperatures) may not faithfully represent the mineral precipitation temperatures. When plotting these apparent temperatures vs. the burial history, only the possible latest ages of fracturing emerged. These ages were further refined by considering petroleum charging, tectonic evolution, and stress orientation. Bitumen-filled fractures likely resulted from the Late Cretaceous uplift, marking the migration of low-maturity hydrocarbons in the study area. Carbonate-filled E-W striking fractures emerged during the late Miocene (∼13–6.5 Ma) alongside fold development. NE-striking fractures that crosscut W-E ones possibly formed recently due to stress reorientation.

Proximal Interphalangeal Joint Arthroplasty for Fracture.

Proximal interphalangeal joint arthroplasties can be performed in the setting of acute comminuted fracture, chronic fracture presentations, and posttraumatic arthritis. These surgeries provide excellent pain relief and patient satisfaction but patients should be cautioned not to expect an improvement in motion postoperatively. Despite high rates of minor complications and radiographic loosening, these implants have good rates of long-term survival with most revisions occurring in the early postoperative period. They provide viable alternatives to arthrodesis, osteotomy and amputation in the appropriate patient.

Arthroscopic-Assisted Fracture Treatment in the Wrist.

Wrist arthroscopy in the setting of wrist fracture affords direct visualization of reduction and identification of associated cartilage and soft tissue injuries. Further, mitigating soft tissue insult in the setting of perilunate injuries may decrease postoperative pain and stiffness while attaining outcomes equivalent to open techniques in appropriately selected patients. Technical proficiency of the surgeon continues to be a limitation of the technique. Randomized controlled studies are needed to better understand outcomes.

Violence, responsibility and best interests: children rights in Elizabeth Harrower’s A Few Days in the Country and Other Stories

Abstract In her short story collection of A Few Days in the Country and Other Stories (2015), contemporary Australian novelist Elizabeth Harrower skillfully portrays a cohort of children who have come of age in diverse fractured family settings since the 1960s. This article delves into the realm of child welfare and best interests in Australia, elucidating the intricate web of family laws that govern these principles. It casts a revealing light on the myriad challenges children confront in contexts marked by family violence, parental separation, and child custody and adoption. This analysis exposes the unfortunate reality where children’s rights are frequently subverted by guardians, effectively preventing their meaningful involvement in familial decision-making. In instances of family violence, children are relegated to the role of silent victims, rendered voiceless by their inability to resist. During divorce proceedings, children are relegated to the sidelines, unable to actively participate in the decision-making process, resulting in the neglect or outright harm of their best interests. Children who find themselves in foster care or adoption situations often respond with unprecedented rebellion, asserting their independence and self-determination beneath the facade of silent victimhood. Tragically, their fundamental rights consistently remain inadequately protected. By undertaking a critical examination of the dynamic between adults and children within the framework of family law and by juxtaposing it with the contemporary portrayal of marginalized children in Australia, as exemplified in Harrower’s works, this article offers multifaceted insights that can guide efforts to safeguard children’s rights and enhance the development and implementation of legislation pertaining to children.

Comparison of Erector Spinae Plane Blocks Versus Multimodal Pain Management for Traumatic Rib Fractures: A Matched Cohort Study

IntroductionErector spinae plane blocks (ESPBs) are frequently utilized when treating patients with multiple rib fractures. While previous work has demonstrated the efficacy of ESPB as an adequate method of pain control, there has been no work comparing a continuous ESPB to “best practice” multimodal pain control. We hypothesize that a continuous ESPB catheter combined with a multimodal pain regimen may be associated with a decrease in opioid requirements when compared to a multimodal pain regimen alone. MethodsThis was a retrospective observational cohort study at a level 1 trauma center from September 2016 through September 2021. Inclusion criteria included patients 18 y or older with at least three unilateral rib fractures who were not mechanically ventilated during admission. The primary outcome was the total morphine equivalents utilized throughout the index admission. ResultsA total of 142 patients were included in this study, 71 in each cohort. Patients included had a mean age of 52.5 y, and 18% were female. Demographic data including injury severity score, total number of rib fractures, and length of stay were similar. While there was a trend toward a decrease in morphine equivalents in the patient cohort undergoing ESPB catheter placement, this was not found to be statistically significant (284.3 ± 244.8 versus 412.6 ± 622.2, P = 0.5). ConclusionsWhile ESPB catheters are frequently utilized for analgesia in the setting of multiple rib fractures, there was no decrease in total opioid usage when compared with patients who were managed with a multimodal pain regimen alone. Further assessment comparing ESPB catheters to best practice multimodal pain control regimens through a prospective, multicenter trial is required to further validate these findings.