Segmental Fractures Research Articles

Effectiveness of sagittal top compression reduction technique in treatment of thoracolumbar vertebral fractures

To investigate the effectiveness of sagittal top compression reduction technique in the treatment of thoracolumbar vertebral fractures. A retrospective analysis was conducted on the clinical data of 59 patients with thoracolumbar vertebral fractures who met the selection criteria and were admitted between November 2018 and January 2022. Among them, 34 patients were treated with sagittal top compression reduction technique (top pressure group), and 25 patients were treated with traditional reduction technique (traditional group). There was no significant difference in baseline data between the two groups ( P>0.05), including gender, age, fracture segment, cause of injury, AO classification of thoracolumbar vertebral fractures, thoracolumbar injury classification and severity (TLICS) score, American Spinal Injury Association (ASIA) grading, surgical approach, preoperative vertebral body index, height ratio of the anterior margin of injured vertebra, injured vertebra angle, segmental kyphosis angle, visual analogue scale (VAS) score, and Oswestry disability index (ODI). The operation time, intraoperative blood loss, and incidence of complications between the two groups were recorded and compared. After operation, VAS score and ODI were used to evaluate effectiveness, and X-ray and CT examinations were performed to measure imaging indicators such as vertebral body index, height ratio of the anterior margin of injured vertebra, injured vertebra angle, and segmental kyphosis angle. There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). No complication such as dural sac, nerve root, or vascular injury was found during operation, and all incisions healed by first intention. Patients in both groups were followed up 6-48 months, with an average of 20.6 months. No loosening, breakage, or failure of internal fixation occurred during follow-up. The imaging indicators, VAS score, and ODI of the two groups significantly improved at 1 week and last follow-up when compared to preoperative ones ( P<0.05). At last follow-up, the VAS score and ODI further significantly improved when compared to 1 week after operation ( P<0.05). At 1 week after operation and last follow-up, the vertebral body index, segmental kyphosis angle, injured vertebra angle, and ODI in the top pressure group were significantly better than those in the traditional group ( P<0.05). There was no significant difference in VAS score and height ratio of the anterior margin of injured vertebra between the two groups at 1 week after operation ( P>0.05), but the two indicators in the top pressure group were significantly better than those in the traditional group at last follow-up ( P<0.05). The treatment of thoracolumbar vertebral fractures with sagittal top compression reduction technique can significantly improve the quality of vertebral reduction, and is superior to traditional reduction techniques in relieving pain and improving spinal function.

Key Trace Elements Zinc and Magnesium Levels Decline After Fracture in a Rat Model

Category: Basic Sciences/Biologics; Basic Sciences/Biologics Introduction/Purpose: Zinc and magnesium are crucial for bone health, and their deficiencies can lead to impaired bone metabolism and repair. Although enhancing their bioavailability has been linked to better fracture healing, their levels during healing have not been studied. We hypothesized that zinc and magnesium levels transiently decrease at the fracture site compared to intact bone. This study is the first to explore temporal trace element levels during the initial stages of fracture healing. The findings will reveal when each element changes its concentration at the fracture site, which is associated with specific functions necessary for appropriate healing. Understanding the connection between trace element concentration and repair processes could lead to more effective treatment or supplementation during fracture healing. Methods: Following induction of a femur fracture in male BB Wistar rats, injured and intact contralateral femurs were harvested at 1- (n=3), 3- (n=4), and 7-days (n=3) after fracture. Fracture segments 10mm in length were resected 5mm from the center of the callus in either direction. Contralateral non-fractured femur segments were resected from the same region within the femoral diaphysis. Samples were analyzed via inductively coupled mass spectrometry using an Agilent ICP-MS 7900 (Agilent Technologies, Santa Clara, CA). Data was converted from ppb to percent weight zinc and magnesium per weight of bone (w/w%). The difference between zinc and magnesium in contralateral intact bone vs. fractured bone was calculated and averaged (∆) for each group. The average % change were also determined. An independent sample two-tailed t-test was performed comparing average w/w% of zinc and magnesium between fracture and contralateral samples. A p-value of &lt; 0.05 was considered significant. Results: After 1-day post-fracture, there was a -29.09 average % change in zinc levels (∆ 6.90x10^-03 ± 5.05x10^-03) (p = 0.033) and a -25.76 average % change in magnesium levels (∆ 1.21x10^-01 ± 7.36x10^-02 w/w%) (p = 0.241) between fractured and non- fractured femurs. After 3-days post-fracture, there was a -22.51 average % change in zinc levels (∆ 5.45x10^-03 ± 3.95x10^-03 w/w%) (p = 0.022) and a -33.07 average % change in magnesium levels (∆ 1.84x10^-01 ± 1.05x10^-01 w/w%) (p = 0.025). After 7- days post-fracture, there was a -9.40 average % change in zinc levels (∆ 1.90x10^-03 ± 3.98x10^-03) (p = 0.377) and a -17.88 average % change in magnesium levels (∆ 9.04x10^-02 ± 1.24x10^-01 w/w%) (p = 0.159) between fractured and non-fractured femurs. Conclusion: Previous research has established the significance of trace elements, namely zinc and magnesium, in the process of fracture healing. Zinc has been shown to improve fracture healing, while magnesium has been found to play a role regulating inflammation during early fracture healing. The findings of this study corroborate our hypothesis that levels of these elements transiently decline following fracture. By evaluating these changes in trace element levels, we can gain a better understanding of their function in the fracture healing process. These observations may offer insight into potential therapeutic approaches utilizing zinc and magnesium for fracture healing in the future.

Management of a pediatric mandibular symphysis fracture with a custom acrylic cap splint

ABSTRACT Traumatic dentoalveolar injuries in pediatric patients are a common occurrence. Treatment strategies for managing mandibular fractures in pediatric patients are dissimilar to that of adult patients. The dynamic nature of bone, developing tooth buds, parent’s levels of apprehension, and the patient’s level of cooperation are some of the factors which dictate the treatment of choice. Treatment rendered should aim at the stabilization of fractured segments with minimum invasiveness. The purpose of this case report is to describe the management of mandibular symphysis fracture in a 1-year-old boy using an acrylic splint which is stabilized with circummandibular wiring.

FRACTURES CAUSES AND TYPES DESCRIPTION IN DRAJAT PRAWIRANEGARA HOSPITAL SERANG INDONESIA

Fractures are often associated with considerable morbidity, leading to extended hospital stays. Disturbances due to fractures impact activity tolerance, thereby reducing productivity. Fracture is a term for loss of continuity of bone or cartilage, either total or partial. In general, a fracture is caused by trauma or physical exertion. This case report consists of four types of fractures in the Drajat Prawiranegara Hospital Serang Indonesia: transverse fractures, cumulative fractures, oblique, segmental, impacted, and spiral fractures. Causes of fractures can be divided into traumatic injuries, direct, indirect, sudden violent contractions, pathological fractures, bone tumours, chronic infections, rickets, and term bone stress. The gold standard examination used to determine the location, type, and severity is an x-ray radiology examination.

Panfacial fractures management, a report of surgical treatment sequence in three cases: A case series study

Multiple facial fractures, which involve the upper, middle, and lower thirds of the face, are called Panfacial fractures, and their management is one of the biggest challenges in the field of maxillofacial surgery. The proximity of maxillofacial skeleton to important sensory or vital structures such as the visual, olfactory, masticatory and respiratory systems and intracranial components in addition to negative effects on esthetic aspects of the face have doubled the intricacy. Small or thin fractured segments that are difficult to find and stabilize make management of pan facial fractures different from anywhere else in the body.&#x0D; One major challenge is to find the best pattern and sequence of treatment. There are different concepts, depending on the surgeon's experience and the pattern of fracture. This study reports three patients with the diagnosis of pan facial fractures. A 54-year-old woman, an 18-year-old and a 14-year-old man that were all victims of road traffic injuries (MVA). Conventional open reduction and internal fixation methods have been used and favorable results have been obtained in follow-up periods.

Effectiveness of TiRobot-assisted and free-hand percutaneous kyphoplasty via pedicle of vertebra in treatment of osteoporotic vertebral compression fracture of thoracic vertebra

To compare the effectiveness of TiRobot-assisted and C-arm X-ray fluoroscopy assisted percutaneous kyphoplasty (PKP) via pedicle of vertebra in the treatment of osteoporotic vertebral compression fracture (OVCF) of thoracic vertebrae. The clinical data of 85 patients with OVCF of thoracic vertebrae who were admitted between January 2020 and March 2023 and met the selection criteria was retrospectively analyzed including 40 patients (50 vertebrae) undergoing PKP assisted by TiRobot (group A) and 45 patients (50 vertebrae) undergoing PKP assisted by C-arm X-ray fluoroscopy (group B). There was no significant difference in the comparison of baseline data such as gender, age, body mass index, bone mineral density T-value, fracture segment, trauma history, and preoperative numerical rating scale (NRS) score, Oswestry disability index (ODI), and Cobb angle of injured vertebra between the two groups ( P>0.05). The effectiveness evaluation indexes of the two groups, including the operation time, the volume of injected cement, the times of fluoroscopies, the length of hospital stay, and the occurrence of postoperative complications were collected and compared. Anteroposterior and lateral X-ray films and CT of the injured vertebra were reviewed at 1 day after operation to observe whether there was cement leakage and to evaluate the distribution of cement in the injured vertebra. Before and after operation, pain was assessed using the NRS score, dysfunction was assessed using the ODI, and vertebral height recovery was assessed by measuring the Cobb angle of the injured vertebrae by X-ray films. Both groups of patients successfully completed the operation, the operation time, the volume of injected cement, the times of fluoroscopies, and the length of hospital stay in group A were significantly less than those in group B ( P<0.05). The patients in two groups were followed up 4-12 months (mean, 9.6 months). Bone cement leakage occurred in 5 vertebrae in group A and 15 vertebrae in group B after operation, all of which leaked to the intervertebral space and around the vertebral body, and the patients had no obvious clinical symptoms. The difference of bone cement leakage between the two groups was significant ( P<0.05). No severe complication such as intraspinal leakage, infection, or vascular embolism was found in the two groups. At 1 day after operation, the distribution index of bone cement in group A was mostly grade Ⅴ, which was well dispersed; while in group B, it was mostly grade Ⅱ and grade Ⅴ; the difference of bone cement distribution index between the two groups was significant ( P<0.05). The NRS score, ODI, and Cobb angle of injured vertebra in both groups were significantly improved at 1 day after operation when compared with preoperative ones ( P<0.05). There was no significant difference in the difference of the above indexes between the two groups before and after operation ( P>0.05). TiRobot-assisted unilateral PKP in the treatment of OVCF of thoracic vertebrae is safe and effective, which can reduce the X-ray transmission times during operation, shorten the operation time, reduce the volume of bone cement injection, and thus decrease incidence of bone cement leakage.

Changing patterns of mid face fractures in 21century-A need to redefine lines

To study the changing patterns of mid face fractures using computed tomography scan. 100 patients with midface fracture requiring open reduction and internal fixation were selected for this study. They underwent 2D and 3D computed tomography scan. The fracture lines were studied radiographically and intraoperatively and compared with the standard Le Fort lines.The study showed that men ranging from age 21-30 years were more likely to suffer midface fracture compared to women M:F =19:5. Road traffic accidents (RTA) happens to be the most common aetiology (78%) followed by assaults and accidental fall. The midface fractures that were encountered were divided into 3 categories after assessing the CT scans as follows- 1. Similar to Le Fort lines-24%; 2. Combination of Le fort lines-12%; 3. Deviation from Le Fort lines-64%.The 64% of patients with deviations were divided into 5 categories- 1. V1: Additional line from the pyriform aperture to the infraorbital rim of the same side. (37.17%); 2. V2: Additional line connecting the Le Fort fracture line to the infraorbital rim. (38.46%); 3. V3: Additional line connecting the pyriform aperture to the orbit's lateral wall without crossing the infraorbital rim on the same side. (12.82%); 4. V4: Additional line involving the fractured segment, running from the infraorbital rim across the canine fossa and finishing on the dentoalveolar segment on the same side. (5.12%); 5. V5: Pterygoid plates not fractured. (6.41%). Every patient with a facial fracture should undergo a complete clinical and radiographic assessment. In order to accurately determine the fracture patterns, it is necessary to review the sectional pictures of the scans coupled with 3D-reconstructed images. Newer classification needs to discussed to describe the deviation caused by high velocity objects. To treat the patient promptly and to establish better communication between the surgeon and radiologist.

Surgical outcomes of segmental diaphyseal forearm fractures in adults: a small case series on plate osteosynthesis, intramedullary nailing, and other surgical methods

BackgroundSegmental fractures often result from high-energy or indirect trauma that causes bending or torsional forces with axial loading. We evaluated surgical outcomes of patients with forearm segmental diaphyseal fractures.MethodsWe retrospectively analyzed data from patients with forearm segmental fractures for which they underwent surgery at the Pusan National University Trauma Center from March 2013 to March 2022. We also analyzed accompanying injuries, injury severity score (ISS), injury mechanism, occurrence of open fracture, surgical technique, and treatment results.ResultsFifteen patients were identified, one with bilateral segmental diaphyseal forearm bone fracture, for a total of 16 cases. Nine of the patients were male. The overall mean age was 50 years, and the mean follow-up period was 16.2 months. Six cases who underwent surgery using plate osteosynthesis achieved bone union without length deformity at final follow-up. Three of seven patients who underwent intramedullary nailing alone underwent reoperation due to nonunion. Six cases achieved bone union at final follow-up, three of which showed length deformity. Three patients underwent surgery using a hybrid method of IM nailing, plates, and mini cables. One patient who underwent surgery with a plate and one patient who underwent surgery with IM nailing alone showed nonunion and were lost to follow-up.ConclusionPlate osteosynthesis is considered the gold standard for treatment of adult forearm diaphyseal segmental fractures. In this study, IM nailing was associated with high rates of non-union and length deformity. However, the combination of IM nailing and a plate-cable system may be an acceptable alternative in segmental diaphyseal forearm fracture, achieving a union rate similar to that provided by plate fixation.

Cycling-related cranio-spinal injuries admitted to a Major Trauma Centre in the cycling capital of the UK

Background The increased popularity of cycling is leading to an anticipated increase in cycling-related traffic accidents and a need to better understand the demographics and epidemiology of craniospinal injuries in this vulnerable road user group. This study aims to systematically investigate and characterise cycling-related head and spine injuries seen in the Major Trauma Centre for the Eastern region, which has the highest cycling rates in the UK. Methods We performed a retrospective cohort study comparing the incidence, patterns, and severity of head and spine injuries in pedal cyclists presenting to the Major Trauma Centre in Cambridge between January 2012 and December 2020. Comparisons of injury patterns, characteristics, and associations were made according to mechanism of injury, helmet use, patient age and gender. Results A total of 851 patients were admitted after being involved in cycling-related collisions over the study period, with 454 (53%) sustaining head or spine injuries. The majority of victims (80%) were male and in mid-adulthood (median age 46 years). Head injuries were more common than spine injuries, with the most common head injuries being intracranial bleeds (29%), followed by skull fractures (12%), and cerebral contusions (10%). The most common spine injuries were cervical segment fractures, particularly C6 (9%), C7 (9%), and C2 (8%). Motorised collisions had a higher prevalence of spine fractures at each segment (p < 0.001) and were associated with a higher proportion of multi-vertebral fractures (p < 0.001). These collisions were also associated with impaired consciousness at the scene and more severe systemic injuries, including a lower Glasgow coma scale (R = −0.23, p < 0.001), higher injury severity score (R = 0.24, p < 0.001), and longer length of stay (R = 0.21, p < 0.001). Helmet use data showed that lack of head protection was associated with more severe injuries and poorer outcomes. Conclusion As cycling rates continue to increase, healthcare providers may expect to see an increase in bicycle-related injuries in their practice. The insights gained from this study can inform the treatment of these injuries while highlighting the need for future initiatives aimed at increasing road safety and accident prevention.

Safety and Efficacy of Resveratrol in Healing of Maxillofacial Fractures: A Randomized Controlled Study.

To assess the efficacy of resveratrol in improving functional outcomes following open reduction and internal fixation of maxillofacial fractures. A single-center, randomized, parallel group, prospective, double-blind clinical trial was conducted on 40 patients between the age 20 and 60years, requiring open reduction and internal fixation of maxillofacial fractures. The selected patients were randomly divided into two groups, Group 1 (placebo) and Group 2 (resveratrol) where tablets resveratrol 500mg were given twice daily for 1month following open reduction and internal fixation of fractured segments. Bite force was calculated pre-operatively and on the 1st, 4th, 8th and 12th week postoperatively. Serum markers osteocalcin and alkaline phosphate were calculated pre-operatively and at 4th and 12th week postoperatively. Bite force (690.55 ± 262.00) in the resveratrol group was higher than the placebo group (553.27 ± 300.08) at 12th week postoperatively. However, the difference was non-significant statistically (p = 0.132). Resveratrol group (116.80 ± 55.25) showed better maintenance of serum ALP level as compared to placebo group (107.90 ± 42.99) at 12th week postoperatively, but again it lacked statistical significance (p = 0.573). Resveratrol group after initial reduction at 4th week showed serum osteocalcin levels nearly equal to the preoperative values at 12th week, while the placebo group showed a decline both at 4th and 12th week postoperatively. However, these results were not statistically significant (p = 0.065). There was no statistically significant difference in bite force, serum ALP level and serum osteocalcin levels between placebo group and resveratrol group. Though not statistically significant but early increased level of serum osteogenic markers, better restoration of bite force in group 2 (tab. Resveratrol) indicates toward its possible optimistic role in maxillofacial fracture healing. More studies with larger sample sizes are needed in order to confirm the efficacy of this drug in maxillofacial fracture.

Modeling two-phase flow behaviour in a shale gas reservoir with complex fracture networks and flow dynamics

In this work, a robust and pragmatic method has been developed, validated, and applied to describe two-phase flow behaviour of a multifractured horizontal well (MFHW) in a shale gas formation. As for a fracture subsystem, its permeability modulus, non-Darcy flow coefficient, and slippage factor have been defined and embedded into the governing equation, while an iterative method is applied to update the gas/water saturation in each fracture segment within discrete fracture networks. Different from the traditional treatment that a water-source/sink in the matrix is simplified by assuming it as a constant term, a skin factor on a fracture face is defined and introduced to represent the change in relative permeability in the matrix domain at each timestep, while the adsorption/desorption term is incorporated into the diffusivity equation to accurately calculate the shale gas production by taking the adsorbed gas in nanoscale porous media into account. Then, the theoretical model can be applied to accurately capture the two-phase flow behaviour in different subdomains. The accuracy of this newly developed model has been confirmed by the numerical simulation and then it is extended to field applications with excellent performance. The stress-sensitivity, non-Darcy flow, and slippage effect in a hydraulic fracture (HF) are found to be obvious during the production, while the initial gas saturation in a matrix and HFs imposes an evident influence on the production profile. As for an HF with a high gas saturation, the dewatering stage is missing and water from the matrix can be neglected during a short production time. For the matrix subsystem, a high-water saturation in the matrix near an HF can affect gas production during the entire stage since gas relative permeability in the HF remains low. In addition, the adsorption/desorption in the matrix subsystem can increase gas production but decrease water production. Compared to the observed gas/water production rates for field applications, the solutions obtained from the method in this work are found to be well matched, confirming its reliability and robustness.

Reconstruction of a Severe Open Tibiofibular Fracture using an Ipsilateral Vascularized Fractured Fibula with a Thoracodorsal Artery Perforator Free Flap.

The Gustilo IIIB tibiofibular fractures often result in long bone loss and extensive soft tissue defects. Reconstruction of these complex wounds is very challenging, especially when it includes long bone grafts, because the donor site is limited. We describe our experience using a set of chimeric ipsilateral vascularized fibula grafts with a thoracodorsal artery perforator free flap to reconstruct the traumatic tibia defects. A 66-year-old male suffered a severe comminuted tibia fracture and segmented fibula fracture with large soft tissue defects as a result of a traffic accident. He also had an open calcaneal fracture with soft tissue defects on the ipsilateral side. All the main vessels of the lower extremity were intact, and the cortical bone defect of the tibia was almost as large as the fractured fibula segment. We used an ipsilateral vascularized fibula graft to reconstruct the tibia and a thoracodorsal artery perforator flap to resurface the soft tissue, using the distal ends of peroneal vessels as named into sequential chimeric flaps. After 3 weeks, the calcaneal defect was reconstructed with second thoracodorsal artery perforator free flap. Reconstruction was successful and allowed rapid rehabilitation because of reduced donor site morbidity.

Surgical fixation of ipsilateral femoral neck and shaft fractures: a matter of debate?

Segmental femoral fractures represent a rare but complex clinical challenge. They mostly result from high-energy mechanisms, dictate a careful initial assessment and are managed with various techniques. These often include an initial phase of damage control orthopaedics while the initial manoeuvres of patient and soft tissue resuscitation are employed. Definitive fixation consists of either single-implant (reconstruction femoral nails) or dual-implant constructs. There is no consensus in favour of one of these two strategies. At present, there is no high-quality comparative evidence between the various methods of treatment. The development of advanced design nailing and plating systems has offered fixation constructs with improved characteristics. A comprehensive review of the existing evidence with a step-by-step description of these different definitive fixation strategies based on three case examples was conducted. Furthermore, the rationale for using single vs dual-implant strategy in its case is presented with supportive references. The prevention of complications relies mainly on the strict adherence to basic principles of fracture fixation with an emphasis on careful preoperative planning, the quality of the reduction, and the application of soft tissue-friendly surgical methods.

Single Burr Hole Repair of Ponds Fracture in Elderly Patient: Rare Presentation

Introduction: Ponds fracture is a common presentation in the young age group. It is not present in elderly patients because of the rigidity of the bone. Methods: In this case report, we are describing a repair of the ponds fracture in elderly patients with an elevation of the fractured segment with a single burr hole. Results: There was complete resolution of the continuity of the bone with 100% elevation of the bone. Conclusion: To our knowledge, pond fracture is not found in elderly patients and this is rare, so we tried to present it with the pictorial representations.

Risk Factors for Cerebrospinal Fluid Leakage After Extradural Spine Surgery: A Meta-Analysis and Systematic Review

Cerebrospinal fluid (CSF) leakage is 1 of the common complications of spine surgery and is largely caused by intraoperative or postoperative dural tears. Associations of different factors with postoperative CSF leakage have not been consistent. In this study we aimed to identify demographic, disease-related, and surgical risk factors for CSF leakage after extradural spine surgery in a systematic review and meta-anlysis. The PubMed, EMBASE, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Wanfang data, Chinese Weipu Database, and SinoMed databases were searched from inception until October 24, 2022. Fixed-effects or random-effects models were used to calculate odds ratios and 95% confidence intervals. The quality of observational studies was evaluated using the Newcastle-Ottawa scale instrument. A total of 15 observational studies with 1,719,923 participants were included in this systematic review. All studies had a Newcastle-Ottawa scale score greater than or equal to 6. Age older than 70years, smoking, ossification of the posterior longitudinal ligament, adhesion of spinal dura, spinal canal stenosis, cervical fracture, spondylolisthesis, revision surgery, and multiple surgical segments were all related to CSF leakage in the pooled analysis. Obesity and disease duration>1year were not associated with the leakage of CSF. This study will provide a reference for the identification of patients at high risk of developing CSF leakage, which suggests clinicians to strengthen the observation of drainage fluid in high-risk groups.

Comparative Evaluation of Masticatory Bite Force in Mandible Fractures Treated with Three-Dimensional Curved Locking Strut Plate Versus Straight Locking Miniplate.

To compare the efficacy of titanium 2.0-mm curved locking strut plate and 2.0-mm straight locking miniplate with regard to their intraoperative use and the stability of fixation achieved both, clinically and radiographically. Forty patients with 62 sites of mandibular fractures requiring open reduction and internal fixation were included in the study. The sample was divided into two groups of twenty patients each depending upon whether patient received three-dimensional 2.0-mm locking curved strut plate (group A) or 2.0-mm straight locking miniplates (group B). Mouth opening, teeth in the fracture line, degree of displacement, time taken, neurosensory and bite force evaluation were done preoperatively, 1st, 7th day, 2nd week, 4th week, 6th week and 12th week postoperatively. Positive correlation was found between preoperative and postoperative bite force values at subsequent follow-up weeks. At 3rd month evaluation, the change in bite force from the previous follow-up visit was significantly greater in group A (locking strut plate) than group B (locking miniplate) in the incisor, left molar and right molar region. Statistically significant difference was observed between the two groups regarding time taken (P < 0.016) depicting less time taken for placement of three-dimensional 2.0-mm locking curved strut plate(group A) 20.30 ± 4.85min as compared to 27.30 ± 6.82min for fixation with 2.0mm straight locking miniplates in group B. The findings were suggestive that the both systems had better adaptation during fixation, comparable radiographic reduction and increased stability in postoperative period. However, 3D locking strut plate took relatively lesser operative time, offered good rigidity and better stabilization of fractured segments in three dimensions along with significant improvement in the masticatory bite force postoperatively.

Robust line segment mismatch removal using point-pair representation and Gaussian-uniform mixture formulation

Line segment matching (LSM) plays an important role in image matching, while it is always a challenging problem due to line fracture and high geometric complexity. In this paper, we propose a line segment mismatch removal to address the sensitivity to segment length and the fracture problem. The mismatch removal removes the massive false matches obtained by the descriptors like LBD. Specifically, we suggest calculating the endpoint error in LSM rather than the direction error in considering the error band and segment length. We propose a point-pair representation, and transform the LSM problem to be an intuitive point-pair alignment problem with a mixture model. The point-pair representation is more robust on the segment length than the linear equation representation used in RANSAC, which significantly preserves short line segments. Then, based on the point-pair representation, we propose a novel Directed Endpoint Drift method to solve the inherent fracture problem of line segments by allowing the endpoints to move along the line to complement the fracture. Compared with the recent learning-based method, the proposed method nearly doubles the number of correct matches on the remote sensing dataset. Especially, the recall is improved by 10% to 30% for both the short segments and the slightly fractured segments, compared with the popular RANSAC and MAGSAC++ methods. The code is available at https://github.com/shenliang16/DEpD.

FracAtlas: A Dataset for Fracture Classification, Localization and Segmentation of Musculoskeletal Radiographs

Digital radiography is one of the most common and cost-effective standards for the diagnosis of bone fractures. For such diagnoses expert intervention is required which is time-consuming and demands rigorous training. With the recent growth of computer vision algorithms, there is a surge of interest in computer-aided diagnosis. The development of algorithms demands large datasets with proper annotations. Existing X-Ray datasets are either small or lack proper annotation, which hinders the development of machine-learning algorithms and evaluation of the relative performance of algorithms for classification, localization, and segmentation. We present FracAtlas, a new dataset of X-Ray scans curated from the images collected from 3 major hospitals in Bangladesh. Our dataset includes 4,083 images that have been manually annotated for bone fracture classification, localization, and segmentation with the help of 2 expert radiologists and an orthopedist using the open-source labeling platform, makesense.ai. There are 717 images with 922 instances of fractures. Each of the fracture instances has its own mask and bounding box, whereas the scans also have global labels for classification tasks. We believe the dataset will be a valuable resource for researchers interested in developing and evaluating machine learning algorithms for bone fracture diagnosis.

How common are refractures in childhood?

The aim of this study was to describe the incidence of refractures among children, following fractures of all long bones, and to identify when the risk of refracture decreases. All patients aged under 16 years with a fracture that had occurred in a bone with ongoing growth (open physis) from 1 May 2015 to 31 December 2020 were retrieved from the Swedish Fracture Register. A new fracture in the same segment within one year of the primary fracture was regarded as a refracture. Fracture localization, sex, lateral distribution, and time from primary fracture to refracture were analyzed for all long bones. Of 40,090 primary fractures, 348 children (0.88%) sustained a refracture in the same long bone segment. The diaphyseal forearm was the long bone segment most commonly affected by refractures (n = 140; 3.4%). The median time to refracture was 147 days (interquartile range 82 to 253) in all segments of the long bones combined. The majority of the refractures occurred in boys (n = 236; 67%), and the left side was the most common side to refracture (n = 220; 62%). The data in this study suggest that the risk of refracture decreases after 180 days in the diaphyseal forearm, after 90 days in the distal forearm, and after 135 days in the diaphyseal tibia. Refractures in children are rare. However, different fractured segments run a different threat of refracture, with the highest risk associated with diaphyseal forearm fractures. The data in this study imply that children who have sustained a distal forearm fracture should avoid hazardous activities for three months, while children with a diaphyseal forearm fracture should avoid these activities for six months, and for four and a half months if they have sustained a diaphyseal tibia fracture.

XFVM modelling of fracture aperture induced by shear and tensile opening.

In reservoir simulation, it is important to understand the mechanical behaviour of fractured rocks and the effect of shear and tensile displacements of fractures on their aperture. Tensile opening directly enhances the fracture aperture, whereas shear of a preexisting rough-walled fracture creates aperture changes dependent on the local stress state. Since fracture dilatation increases reservoir permeability, both processes must be included in a realistic and consistent manner into the mechanical reservoir simulation model. Here, we use the extended finite volume method (XFVM) to conduct flow and geomechanics simulations. In XFVM, fractures are embedded in a poroelastic matrix and are modelled with discontinuous basis functions. On each fracture segment the tractions and compressive forces are calculated, and one extra degree of freedom is added for both the shear and tensile displacement. In this particular XFVM implementation we assume that linear elasticity and steady state fluid pressure adequately constrain the effective stress. In this paper, shear dilation is not calculated a posteriori, but it enters the equations such that aperture changes directly affect the stress state. This is accomplished by adding shear dilation to the displacement gradients and therefore ascertains a consistent representation in the stress-strain relations and force balances. We illustrate and discuss the influence of this extra term in two simple test cases and in a realistic layer-restricted two-dimensional fracture network subjected to plausible in situ stress and pore pressure conditions.