Frequency Of Fractures Research Articles

Is there a femoral morphology at risk of a cervical or pertrochanteric fracture? Description and validation of the “Neck shaft ratio” and the “Intertrochanteric distal ratio” after analyzing a continuous cohort of 126 bilateral fractures of the proximal femur

BackgroundProximal femur fractures constitute a public health concern given their high frequency and the aging population. The frequency of a contralateral fracture occurring can reach up to 15% of cases. Certain historical or demographic factors constitute risk factors for refracture, but the type of fracture, either of the femoral neck (FN) or pertrochanteric (PT), cannot be predicted. The objectives of this retrospective study were: firstly, to analyze several anatomical markers in order to determine whether they predispose to a certain type of fracture in the event of contralateral refracture, and secondly, to determine the predictive power of these possible radiological markers for the type of contralateral fracture. HypothesisThe hypothesis was that the “Neck shaft ratio” (NSR) and the “Intertrochanteric distal ratio” (ITDR) made it possible to determine a proximal femoral morphology at risk of FN and/or PT fracture in the event of a second fracture. Material and methodsThis continuous retrospective single-center series from January 2011 to December 2019 of patients who presented with bilateral fractures of the proximal femurs was analyzed. Radiographs, taken after the first fracture, of the contralateral femur were studied. Morphological measurements previously described in the literature were carried out as well as the NSR (ratio of the medial cortical thicknesses of the femoral neck at its narrowest and basicervical level) and the ITDR (ratio of the medial diaphyseal cortical thicknesses at 5mm and 20mm from the distal portion of the lesser trochanter). One hundred and twenty-six patients were included: 46/126 (36.5%) had bilateral FN, 50/126 (39.7%) bilateral PT and 30/126 (23.8%) one of each. ResultsOnly NSR and ITDR were significant predictive measures for FN or PT fracture type [0.54±0.11 vs. 0.81±0.16 (p<0.0001) and 0. 85±0.1 vs. 0.68±0.1 (p<0.0001), respectively]. These two ratios had an excellent predictive value for the type of fracture occurring on the contralateral side [NSR: AUC ROC = 0.91 (95% CI; 0.86–0.96); ITDR: AUC ROC = 0.81 (95% CI; %, 0.74–0.89)]. The NSR had excellent intra- and inter-observer reproducibility with an interclass correlation coefficient of 0.93 [95% CI: 0.86–0.97] and 0.91 [95% CI: 0.82–0.96] respectively, the same also applied for the ITDR with interclass correlation coefficient values of 0.93 [95% CI: 0.87–0.97] and 0.86 [95% CI: 0.73–0.93] respectively. DiscussionThe NSR and ITDR ratios offer a simple and reproducible means to predict a morphological predisposition to a certain fracture type, respectively an FN and PT on the side contralateral to an initial osteoporotic proximal femur fracture. A prospective cohort study would be useful in defining a possible prognostic nature on the occurrence and/or time until refracture. Level of evidenceIII; retrospective control case.

The Influence of Explosive and Rock Mass Properties on Blast Damage in a Single-Hole Blasting

In rock blasting for mining production, stress waves play a major role in rock fracturing, along with explosive gases. Better energy distribution improves fragmentation and safety, lowers production costs, increases productivity, and controls ore losses and dilution. Blast outcomes vary significantly depending on the choice of the explosive and the properties of the rock mass encountered. This study analyzes the effects of rock mass and explosive properties on blast outcomes via numerical simulation using data from the case study, and later validates the simulation results from the field blast fragmentation. The findings suggest that, for a given set of rock properties, the choice of explosive has a major influence on the resulting fragmentation. Strong explosives (high VOD and detonation pressure) favor large fracture extents in hard rocks, while weaker explosives offer a better distribution of explosive energy and fractures. The presence of rock structures such as rock contacts and joints influences the propagation of stress waves and fractures depending on the structures’ material properties, the intensity and orientations, and the direction and strength of the stress wave. When the stress wave encounters a contact depending on its direction, it is enhanced when traveling from soft to hard and attenuates in the opposite direction. The ability of the stress wave to cause fracturing on the opposite side of the contact depends on the intensity of the transmitted wave and the strength of the rock. Transmitted wave intensity is a function of the strength of the incident wave and the impedance difference between the interface materials. The presence of joints in the rock mass affects the propagation of the stress wave, mainly depending on the infill material properties and the angle at which the stress wave approaches the joint. Less compressible, higher stiffness joints transmit more energy. More energy is also transmitted in the areas where the stress wave hits the joint perpendicularly. Joints parallel to the free face offer additional fracturing on the opposite side of the joint. Other parameters, such as the joint width, continuity, fracture frequency, and the distance from the charge, enhance the effects. To achieve effective fragmentation, the blast design should mitigate the effect of variability in the rock mass via explosive selection and pattern design to ensure adequate energy distribution within the limits of geometric design.

Biochemical characteristics and clinical manifestation of normocalcemic primary hyperparathyroidism.

Normocalcemic primary hyperparathyroidism (nPHPT) is a condition characterized by persistently high levels of parathyroid hormone (PTH) and normal serum calcium levels in the absence of other causes for secondary hyperparathyroidism. The aim of the present study was to assess the clinical presentation and the biochemical characteristics in patients with nPHPT and to compare them with those in patients with hypercalcemic PHPT (hPHPT). The study included 316 patients (277 women and 39 men, average age 58.7 ± 12.1) diagnosed with PHPT. Total serum calcium, inorganic phosphates (PO4), PTH, urinary Ca (uCa), albumin, creatinine, 25(OH)D and bone markers (b-CTX and ALP) were examined in all of them. BMD of the lumbar spine (LS), distal third of the radius (DR), femoral neck (FN) and total proximal femur (TF) were measured by a dual-energy X-ray absorptiometry (DXA). The patients were divided into two groups according to albumin-corrected calcium (Ca) level - with hPHPT (Ca>2.62 mmol/L) and with nPHPT (Ca 2.12-2.62 mmol/l), without other causes for secondary hyperparathyroidism. The frequency of nPHPT was 15.2%. Normocalcemic patients had lower levels of PTH, higher PO4 and 25(OH)D, and smaller parathyroid adenomas. No significant difference in the frequency of osteoporosis, low-energy fractures, nephrolithiasis and gastrointestinal disorders was found between nPHPT and hPHPT. There was no difference in BMD between the two groups. The patients with nPHPT show a more favorable biochemical profile compared to those with hPHPT. Nevertheless, clinical manifestations and complications are similar, without a significant difference in the frequency of osteoporosis, nephrolithiasis, gastrointestinal disorders and low-energy fractures.

Hyperandrogenism associated with polycystic ovary syndrome may have a protective effect against fracture risk in female athletes: A pilot study.

Polycystic ovary syndrome (PCOS), characterized by polycystic ovaries, anovulation, and hyperandrogenism, is believed to be an evolutionary mismatch disease. Past research has examined PCOS as a uniform disease, despite variation in phenotypes across diagnostic categories, but establishing an evolutionary mismatch requires a focus on individual traits. We suggest PCOS hyperandrogenism may have been beneficial in ancestral environments because it reduced fracture risk and associated morbidity and mortality due to increased bone mineral density (BMD). We test this hypothesis by assessing fracture frequency, a proxy for BMD, in highly active females with and without PCOS hyperandrogenism. Sixty-seven reproductive-aged women were surveyed and grouped as: high intensity interval training (HIIT; a proxy for metabolic and physical stress) athletes with hyperandrogenic PCOS (31.24%), HIIT athletes without PCOS (29.85%), and nonathletes with hyperandrogenic PCOS (38.81%). Fracture occurrence was compared between the groups using independent samples Kruskal-Wallis tests for non-normally distributed data, and multiple regression analysis was used to examine anthropometrics, lifestyle and reproductive factors, PCOS status, and exercise frequency on fracture occurrence. Fracture occurrence was higher in non-PCOS athletes (3.8 ± 4.3) than PCOS-athletes (1.2 ± 1.4, p = .11) and PCOS-non-athletes (1.0 ± 1.4, p < .01). PCOS-athletes and nonathletes did not differ significantly in fracture occurrence (p = .33). These results were independent of factors associated with bone health. These preliminary findings suggest females with PCOS-related hyperandrogenism may be less likely to experience bone fractures and provide an initial step to explaining why PCOS has persisted despite marked negative reproductive consequences in modern populations.

Spatial Variations of Deformation along a Strike-Slip Fault: A Case Study of Xianshuihe Fault Zone, Southwest China

The distribution of damage zones around a fault has long been regarded as a frontier and hot spot in the field of geoscience but is still not fully understood. In this study, we conducted field investigations and tests around the Xianshuihe fault zone (XSHF), a left-lateral strike-slip fault with a length of about 400 km located in the eastern margin of the Tibetan Plateau. The results reveal that the fracture frequency and rock strength parameters present a spatially asymmetric distribution along the fault and have a negative power-law correlation with the distance from the fault. The widths of the damage zones are approximately 20.8 km and 17.1 km in the southwest and northeast directions, respectively. Combined with the previous studies, we presented a negative power-law function to depict the correlation between slip displacement and the width of the damage zone and found that the growth rate of damage zone in faults with low displacement is greater than that in those with large displacement. The study demonstrates that the asymmetric distribution of the damage zone surrounding the XSHF is mainly due to the stress redistribution in different damage zones stemming from the left echelon and different activity rates of the blocks on both sides of the XSHF.

Correlation between Malocclusion and Mandibular Fractures: An Experimental Study Comparing Dynamic Finite Element Models and Clinical Case Studies.

Mandibular fractures are very common in maxillofacial trauma surgery. While previous studies have focused on possible risk factors related to post-operative complications, none have tried to identify pre-existing conditions that may increase the risk of mandibular fractures. We hypothesized, through clinical observation, that anatomical conditions involving poor dental contacts, such as malocclusions, may increase the risk of mandibular fractures. This work was subdivided into two parts. In the first part, Digital Imaging and Communications in Medicine (DICOM) data of four healthy patients characterized by different dentoskeletal occlusions (class I, class II, class III, and anterior open bite) have been used to develop four finite element models (FEMs) that accurately reproduce human bone structure. A vertical and lateral impact have been simulated at increasing speed on each model, analyzing the force distribution within the mandibular bone. Both vertical and lateral impact showed higher level of stress at the impact point and in the condylar area in models characterized by malocclusion. Specifically, the class III and the open bite models, at the same speed of impact, had higher values for a longer period, reaching critical stress levels that are correlated with mandibular fracture, while normal occlusion seems to be a protective condition. In the second part of this study, the engineering results were validated through the comparison with a sample of patients previously treated for mandibular fracture. Data from 223 mandibular fractures, due to low-energy injuries, were retrospectively collected to evaluate a possible correlation between pre-existing malocclusion and fracture patterns, considering grade of displacement, numbers of foci, and associated CFI score. Patients were classified, according to their occlusion, into Class I, Class II, Class III, and anterior open bite or poor occlusal contact (POC). Class I patients showed lower frequencies of fracture than class II, III, and open bite or POC patients. Class I was associated with displaced fractures in 16.1% of cases, class II in 47.1%, class III in 48.8% and open bite/POC in 65.2% of cases (p-value < 0.0001). In class I patients we observed a single non-displaced fracture in 51.6% of cases, compared to 12.9% of Class II, 19.5% of Class III and 22.7% of the open bite/POC group. Our analysis shows that class I appears to better dissipate forces applied on the mandible in low-energy injuries. A higher number of dental contacts showed a lower rate of multifocal and displaced fractures, mitigating the effect of direct forces onto the bone. The correlation between clinical data and virtual simulation on FEM models seems to point out that virtual simulation successfully predicts fracture patterns and risk of association with different type of occlusion. Better knowledge of biomechanics and force dissipation on the human body may lead to the development of more effective safety devices, and help select patients to plan medical, orthodontic/dental, and/or surgical intervention to prevent injuries.

Assessment of Bone Mineral Density in a cohort of Juvenile Idiopathic Arthritis patients

Introduction: Low bone mass is encountered in patients with Juvenile idiopathic arthritis (JIA) as a serious long-term complication of this pediatric condition and may be associated with fractures and its complications.&#x0D; The present study aimed to evaluate the frequency of low bone mineral density (BMD) and fragility fractures in patients with JIA in its polyarticular or oligo articular forms. Secondary, our aim was to identify factors associated with low bone mass.&#x0D; Patients and methods: This is a retrospective study conducted on 26 patients with JIA meeting the ILAR criteria for poly or oligoarticular form. Patients were divided into two groups according to their age : group1 including patients aged over 16 years-old and group 2 including patients aged under 16 years-old. Sociodemographic, clinical, biological and functional data were collected by consulting patient’s medical records. Bone mineral density was measured at three different sites: whole body, lumbar spine and hip using the dual-energy X-ray absorptiometry (DXA) equipment. Data were entered and analyzed using SPSS version 11.5 software.&#x0D; Results: Twenty-six JIA patients including 20 females (74.1%) and six males (22.2%) were enrolled with a mean disease duration of 20.23 years [2-54 years]. The mean age was 28.2 years [7-58 years]. The distribution of JIA subtypes among patients was as follows: 6 with oligo articular JIA and 20 with polyarticular JIA. Sixteen patients (59%) practiced regular physical activity. In our series, the frequency of low bone mineral density was 41% in children with JIA and 68 % in adults with JIA. Only two patients presented a fragility fracture in adulthood represented by a hip fracture following low-energy trauma and treated surgically in both cases. No patient received an anti-osteoporotic treatment. In-group 1, there was a significant correlation between low bone mass and weight (p=0.020), BMI (p=0.028), disease duration (p=0.045), positivity of AAN (p=0.050), disease activity (p=0.019), oral corticosteroid (p=0.034) and biologic treatment (p=0.043). In-group 2, a statistically significant correlation was found between low bone mass and age at the time of JIA diagnosis (p=0.041), weight (p=0.03), physical activity (p=0.05), disease duration (p=0.021), functional impact of the disease assessed by the HAQ score (p=0.018), oral corticosteroid therapy (p=0.014) and biological therapy (p=0.012).&#x0D; Conclusion: our study showed that a combination of factors contributed to compromise bone health in patients with JIA. Fragility fractures were rare and occurring mainly in adulthood. An adequate control of disease activity, proper management of treatment, adequate calcium and vitamin D intake, as well as regular physical activity, may contribute to preserve bone health in those patients.

Osteoporosis management in patients with chronic kidney disease (ERCOS Study): A challenge in nephrological care

Fracture risk assessment in patients with chronic kidney disease (CKD) has been included in the CKD-MBD ("Chronic Kidney Disease-Mineral and Bone Disorders") complex in international and national nephrology guidelines, suggesting for the first time the assessment of bone mineral density (BMD) if the results can influence therapeutic decision-making. However, there is very little information on actual clinical practice in this population. The main objective of the ERCOS (ERC-Osteoporosis) study is to describe the profile of patients with CKD G3-5D with osteoporosis (OP) and/or fragility fractures treated in specialized nephrology, rheumatology and internal medicine clinics in Spain. Fifteen centers participated and 162 patients (mostly women [71.2%] postmenopausal [98.3%]) with a median age of 77 years were included. Mean estimated glomerular filtration rate (eGFR) was 36 mL/min/1.73 m2 and 38% of the included patients were on dialysis. We highlight the high frequency of prevalent fragility fractures [37.7%), mainly vertebral (52.5%) and hip (24.6%)], the disproportionate history of patients with glomerular disease compared to purely nephrological series (corticosteroids) and undertreatment for fracture prevention, especially in nephrology consultations. This study is an immediate call to action with the dissemination of the new, more proactive, clinical guidelines, and underlines the need to standardize a coordinated and multidisciplinary care/therapeutic approach to these patients in an efficient way to avoid current discrepancies and therapeutic nihilism.

Valgising angular stable plate fixation in the treatment of multifragmentary proximal humeral fractures in elderly patients.

The frequency of proximal humeral fractures shows an increasing tendency, especially in the elderly, who are frequently affected by osteoporosis. The adequate treatment of complex, displaced fractures poses a serious challenge. Among surgical treatment options, osteosynthesis with an angular stable plate is preferred, however, the implant-related complication rate may be exceptionally high. In our present study, we report the short-term outcomes of our new method of valgising angular stable plate fixation which we use for multifragmentary, displaced proximal humeral fractures in elderly patients. We retrospectively evaluated the clinical and radiological outcomes of 52 patients (46 female and 6 male, age: 71.9 ± 9.6) who suffered dislocated three- or four-part fractures and underwent valgising angular stable plate fixation. Mean follow-up time was 17.3months, while the functional outcomes were as following: excellent in 26, good in 18, moderate in 5 and poor in 3 patients. The mean Constant-Murley Score was 82.5 ± 11.2. Functional outcomes only showed significant correlation (p = 0.031) with age and were proven unrelated to fracture type, BMI and known primary diseases. The cumulative complication rate was 9.6% and revision rate was 5.8%. Neurological deficit, pseudoarthrosis or avascular humeral head necrosis did not occur during the follow-up period. Valgising angular stable plate fixation that we apply for proximal humeral fractures provided favourable functional outcomes and a low postoperative complication rate due to the optimal head and plate placement. The method is especially effective for the treatment of displaced three- and four-part fractures with weakened, osteoporotic bone structure.

Fracture Morphology Influencing Supersonic CO2 Transport: Application in Geologic CO2 Sequestration

AbstractGeologic carbon sequestration requires CO2 injection into the storage formation at high‐injecting pressure. Such high pressure could induce choked flow accompanying huge variations in thermodynamic properties of CO2 at a converging‐diverging (CD) fractures in the storage formation. In this study, high‐velocity CO2 transport through CD fractures was investigated to quantify the effect of fracture morphology on occurrence of both choked flow and shockwave that constrain the mass flow rate of fluid. In addition, variations in thermodynamic CO2 properties including Mach Number (Ma), defined by the ratio of fluid velocity to sound speed, and shock properties were investigated. The morphological characteristics of CD fractures were determined by nine properties, such as throat diameter, throat length, inlet diameter, outlet diameter, throat diameters of two‐connected CD fractures, fracture wall curvature, roughness amplitude, and frequency. As a result, the throat diameter crucially affected choked flow occurrence and maximum Ma. When the inlet and outlet diameters varied, the profiles for Ma variation were consistent in the converging and diverging segments, respectively. In addition, regardless of change in the throat length, the position of maximum Ma was nearly constant with showing the position length ratio of 0.13–0.14. However, roughness of fracture wall significantly influenced the Ma variation and occurrence of shock. In particular, backflows segregated from the main CO2 flow were observed near the wall roughness.

Three-Dimensional Mapping of Scapular Body, Neck, and Glenoid Fractures.

The purpose of this study was to report patterns of scapular fractures and define them with a contemporary methodology. . Retrospective study, 2015-2021. Single, academic, Level 1 trauma center. Consecutive patients ≥18 years, presenting with unilateral scapula fracture, with thin-slice (≤0.5-mm) bilateral computed tomography (CT) scans of the entirety of both the injured and uninjured scapulae. Thin-slice (0.5-mm) CT scans of injured and normal scapulae were obtained to create three-dimensional (3D) virtual models. 3D modeling software (Stryker Orthopedics Modeling and Analytics, Stryker Trauma GmbH, Kiel, Germany aka SOMA) was used to create a 3D map of fracture location and frequency. Fracture zones were delineated using anatomic landmarks to characterize fracture patterns. Eighty-seven patients were identified with 75 (86%) extra-articular and 12 (14%) intra-articular fractures. The dominant fracture pattern emanated from the superior lateral border (zone E) to an area inferior to the spinomedial angle (zone B) and was present in 80% of extra-articular fractures. A second-most common fracture line propagated from the primary (most-common) line toward the inferior medial scapular border with a frequency of 36%. Bare zones (with 1 or no fractures present) were identified in 4 unique areas. Furthermore, intra-articular fractures were found to be heterogenous. The 3D fracture map created in this study confirmed that extra-articular scapular fractures occur in certain patterns with a relatively high frequency. Results provide greater insight into scapular fracture locations and may help to study prognosis of injury and improve treatment strategy including operative approaches and surgical tactics.

A Five-year Study (2014-2019) of the Etiology and Prevalence of Maxillofacial Fractures in Children Referring to Imam Khomeini Hospital of Ahvaz (2014-2019)

Background and Objectives Facial fractures in children are unusual injuries that make up to 15% of facial fractures. Although maxillofacial trauma is more common in children than in adults, the incidence of facial fractures is lower. Epidemiology and etiology of facial fractures vary from country to country, and depend largely on economic group, culture, and geographical area. Maxillofacial fractures are the most common type of facial fractures. Subjects and Methods This 5-year (2014-2019) retrospective observational-descriptive and cross-sectional study was performed among pediatric patients (1 to 12 years old) referring to the maxillofacial surgery department of Imam Khomeini Hospital in Ahvaz (due to trauma and jaw fracture). The indicators included age, sex, time, cause of fracture, fracture position, type of fracture, and existence of accompanying fracture. Results Based on the results obtained in this study, 32.7% of the participants were girls and 67.3% were boys. The most common causes of jaw fractures were MVA (63.4%) and falling (25%). The highest frequency of jaw fracture due to trauma (17.3%) was at the age of 12 years followed by the ages of 9 and 10 years (15.4%). The highest rate of jaw fracture due to trauma in children (1 to 12 years) was in summer (32.7%). The results of this study show that the most common type of fractures was in the mandible (87.5%) which was more reported in males. The most common treatments used were close reduction (67.3%) and ORIF (26.9%). Conclusion The results of this study show that the most common type of fractures are in the mandible and more in men. The highest rate of fractures was reported between the ages of 8 to 12 years. This study showed that the highest percentages of the cause of jaw fractures were MVA and falling, respectively. Also, the highest percentage of hydrotherapy methods used were close reduction and ORIF.

Epidemiology and Sex-Specific Analysis of Basketball-Related Lower Extremity Fractures: A 10-Year Analysis of National Injury Data.

Basketball-related fractures involving the lower extremities frequently present to emergency departments (ED) in the United States (US). This study aimed to identify the primary mechanisms, distribution, and trends of these injuries. We hypothesize that (1) lower extremity fracture frequency will decrease from 2013 to 2022, (2) the ankle will be the most common fracture site, and (3) noncontact twisting will be the most common injury mechanism. Descriptive epidemiological. Level 3. The National Electronic Injury Surveillance System (NEISS) was queried for lower extremity fractures from basketball presenting to US EDs from January 1, 2013 to December 31, 2022. Patient demographics, injury location, and disposition were recorded. The injury mechanism was characterized using the provided narrative. National estimates (NEs) were calculated using the NEISS statistical sample weight. Injury trends were evaluated by linear regression. There were 6259 cases (NE: 185,836) of basketball-related lower extremity fractures. Linear regression analysis of annual trends demonstrated a significant decrease in lower extremity fractures over the study period (2013-2022: P = 0.01; R2 = 0.64). The most common injury mechanism was a noncontact twisting motion (NE: 49,897, 26.9%) followed by jumping (NE: 39,613, 21.3%). The ankle was the most common fracture site (NE: 69,936, 37.6%) followed by the foot (NE: 49,229, 26.49%). While ankle and foot fractures decreased significantly (P < 0.05), fractures of the lower leg, knee, toe, and upper leg showed no significant trends (P = 0.09, 0.75, 0.07, and 0.85, respectively). Basketball-related lower extremity fractures decreased from 2013 to 2022, with the ankle being the most common fracture site and most fractures arising from a noncontact twist. Increasing utilization of outpatient clinics may have contributed to the decline, particularly for ankle and foot fractures. The prevalence of ankle fractures and twisting-related injuries reinforces the importance of protective footwear and targeted strengthening protocols.

Osteoporotic vertebral fractures of the thoracic and lumbar spine

The frequency of osteoporotic vertebral fractures in the clinical routine is increasing due to the demographic change. They are the most frequent fractures associated with osteoporosis and affect an especially morbid and vulnerable group of patients. These fractures often occur after minor trauma or spontaneously. Pain is the predominant symptom, whereas mechanical stability is mostly sufficient, in comparison to vertebral fractures after high-energy trauma, and is not a predominant indication for surgery. These fractures can be described using the classification for fractures associated with osteoporosis and the corresponding treatment recommendations are guided by them. Besides the specific treatment of osteoporotic vertebral fractures, a holistic treatment of patients taking pre-existing comorbidities into consideration is decisive. A mobilization as quickly as possible and treatment of the underlying osteoporosis are important to prevent further fractures.

Nonunions after intertrochanteric and subtrochanteric femoral fractures

The overall frequency of proximal femoral fractures means that we are repeatedly confronted with failed healing and implant failure, despite arelatively low nonunion rate especially in intertrochanteric fractures (< 5%). The aim of this paper is to present our approach to treating these nonunions of the proximal femur and discuss the treatment results. Between 2009 and 2023, patients with nonunion of the proximal femur were retrospectively identified and analyzed. Age, gender, time to revision, the Weber-Cech classification of pseudarthrosis and radiographic imaging before and after revision were analyzed. Atotal of 66patients were analyzed. The mean age was 58years (range 25-88years). The overall healing rate was 88% with amean consolidation time of 8months (range 2-29months). The main osteosynthesis procedures were plate osteosynthesis (n = 45, of which 44 were blade plates), and nail replacement (n = 12). Other procedures included augmentative plate osteosyntheses (n = 4), isolated cancellous bone graft (n = 2), nail dynamization (n = 2), and the use of adynamic hip screw (n = 1). The analysis of our treatment data as well as the current literature, revealed atrend towards intramedullary revision procedures. Implants that can be used to correct the CCD angle, such as the blade plate, remain apredictable option to achieve correction, especially in nonunions with an increased degree of varus. Particularly in the subtrochanteric region, fractures can also be treated in atargeted manner by acombination of mechanical and biological methods with areamed nail change to alarger caliber implant.

Efficacy of a novel cervical dislocation tool for humane euthanasia of broilers and broiler breeders

Euthanasia is an essential task performed daily on commercial poultry farms around the world to safeguard animal welfare. Manual cervical dislocation (MCD) is the most common euthanasia method but can be challenging to perform given the physical strength required to implement this technique. Therefore, the objective of this study was to evaluate the efficacy of a Novel Cervical Dislocation Tool (NCDT) compared to MCD. A total of 60 Ross 308 chickens (6-weeks old) and 60 Ross 706 parent stock breeders (21-weeks old) were enrolled in the study. Birds were sexed, blocked by body weight, and allocated to one of two treatments: 1) MCD and 2) NCDT. Immediately following euthanasia application, insensibility and death was monitored. Once death was confirmed, gross evaluation, radiograph and macroscopic/microscopic scoring was performed. Both euthanasia methods were 100% effective in achieving insensibility followed by cardiac and respiratory arrest in both age groups. In six-week-old broilers, there were no differences in insensibility measures or location and severity of the dislocation site by treatment. The NCDT treatment group showed an increased frequency of fractures located at the tooth-like process that projects from the cranial aspect of the centrum of the axis (dens) but had no impact on bird insensibility. For parent stock, differences in Nictitating Membrane Reflex (NMR) and laceration scores for birds euthanized with NCDT were found and likely associated with additional force exerted with the tool. The NCDT is a promising replacement for manual cervical dislocation (MCD) and future work should address the development of free and accessible training materials for on-farm use.

The hazards of the pastoralist lifestyle: Evidence from postcranial fractures in Middle Bronze and Early Iron Age populations of the Forest‐Steppe Altai, Russia

AbstractA global comparison has shown that subsistence‐specific practices influenced the risk of postcranial fractures in prehistoric hunter‐gatherers and agriculturalists. Much less is known about pastoralists in this regard. The aim of the study was to investigate the prevalence and patterns of postcranial injuries of herders in the Forest‐Steppe Altai, Russia. Skeletal samples associated with the Andronovo Culture of the Middle Bronze Age, and Staroaleyka and Kamen Cultures of the Early Iron Age were studied. Long bones of 595 adults were examined for evidence of antemortem and perimortem injuries. Fracture frequencies were calculated per individual and per skeletal element, and the differences were evaluated statistically. While assessing per individual, the relative risk with a 95% confidence interval was calculated as well. All of the observed fractures were healed. This study suggests that pastoralists sustained not only traumatic, but also stress injuries. There were sex‐related differences in the rates, patterns, and location of the injuries. In the males, the main reason of fractures could have been high‐velocity incidents during horseback riding and using horse‐drawn vehicles. In the females, the majority of the injuries were possibly associated with accidents when walking (short falls and twists of ankle) and milking. Females of the Staroaleyka Culture sustained fractures of the limb bones significantly more often than those of the Kamen Culture, probably as a result of differences in their daily activities. In terms of the total fracture rates, the Forest‐Steppe Altai pastoralists and their neighbors seem to have surpassed low‐intensity agriculturalists but lag behind hunter‐gatherers and high‐intensity agriculturalists. More datasets are needed to further elucidate the association between postcranial fracture risk and subsistence‐specific practices and environments within the Eurasian Steppe, where pastoralism has been the predominant form of economic activity for millennia.

GH receptor polymorphisms guide second-line therapies to prevent acromegaly skeletal fragility: preliminary results of a pilot study.

Skeletal fragility is characterized by increased frequency of vertebral fractures (VFs) in acromegaly. Several trials were conducted to identify modifiable risk factors and predictors of VFs, with limited data on the prognostic role of GH receptor (GHR) isoforms. In this study, we investigated the potential role of GHR polymorphism on the occurrence of incidental VFs (i-VFs), in patients treated with second-line medical therapies. A longitudinal, retrospective, observational study was conducted on a cohort of 45 acromegalic patients not-responsive to first-generation somatostatin receptor ligands (fg-SRLs) and treated with GHR antagonist (Pegvisomant) or with the second-generation SRLs (Pasireotide long-acting release). Second line treatments were Pegvisomant plus fg-SRLs in 26 patients and Pasireotide LAR in 19 patients. From the group treated with fg-SRLs+Peg-V, the fl-GHR isoform was identified in 18 patients (69.2%) and the d3-GHR isoform in 8 patients (30.8%). I-VFs arose exclusively in fl-GHR isoform carriers (p=0.039). From the group treated with Pasireotide LAR, the fl-GHR isoform was identified in 11 patients (57.9%), and the d3-GHR isoform in 8 patients (42.1%). I-VFs arose exclusively in d3-GHR isoform carriers (p=0.018). Patients with fl-GHR isoform had a higher risk for i-VFs if treated with fg-SRL+Peg-V (OR: 1.6 95%IC: 1.1-2.3, p=0.04), and a lower risk if treated with Pasi-LAR (OR: 0.26 IC95%: 0.11-0.66, p=0.038). Our data support a predictive role of the GHR isoforms for the occurrence of i-VFs in acromegalic patients treated with second-line drugs, tailored to the individual patient. The knowledge of the GHR polymorphism may facilitate the choice of second-line therapies, improving the therapeutic approach, in the context of personalized medicine.

Fractures in faulted sandstone reservoir

The Chang 8 Member of the Yanchang Formation in southwest Ordos Basin is a typical faulted sandstone oil reservoir. The development characteristics of fractures have obvious controlling effect on the formation of sweet spots of tight reservoir. In this paper, taking the Chang 8 Member of the southwestern Ordos Basin as an example, the development characteristics and controlling factors of fractures in faulted sandstone oil reservoir are systematically studied. The results show that the faulted sandstone oil reservoirs in the study area are distributed along the main strike-slip faults. The fracture system includes vertical fractures and horizontal bedding fractures. The fracture surface of vertical fractures generally has good oil display, and mostly presented as oil spot and oil immersion level; however, the oil level of horizontal bedding fractures is usually presented as oil spot level. The development frequency of horizontal bedding fractures is 62.5 %, while that of vertical fractures is 37.5 %. The fractures are mainly developed in fine sandstone and a small amount of medium-grained sandstone and siltstone. The factors that affect the fracture development degree in faulted oil reservoir include the distance from main fault, sand thickness, lithology and structural location. For the Jinghe and Honghe Oilfields, the degree of fracture development decreases sharply when the distance from the main fault is greater than 1.25 km and 1.5 km, respectively. Single sand body thickness also controls the degree of fracture development. Single sand bodies with thickness within 6 m have more developed fractures, and the fracture development decreases sharply when the thickness exceeds 6 m. The sand body in the wing part of river channel is relatively thin with fine grain size and small compacted space, which is easy to break under tectonic activity. The fractures of the Chang 8 Member in the study area are mainly developed near the faults, the top of anticline and its wing part.

Fiber-Optics Approach Monitors Drainage Profile of Multistage Stimulation

_ This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper SPE 212364, “Can You Feel the Pressure? Strain-Based Pressure Estimates,” by Kyle Haustveit, SPE, and Jackson Haffener, SPE, Devon Energy. The paper has not been peer reviewed. _ The combination of horizontal wells and hydraulic stimulation has been key in unlocking vast unconventional resources across North America and elsewhere, but much remains to be understood regarding how the reservoir is drained across the miles of laterals accessing a resource. The density of pressure gauges required to accurately measure the drainage pattern from a horizontal multistage stimulation is currently not realistic economically or technologically. In this case study, the authors describe a method of monitoring the drainage profile of a horizontal multistage stimulation using optical fiber. Introduction An advanced subsurface diagnostic project was deployed as part of the Hydraulic Fracture Test Site I, Phase 3, funded by the Department of Energy. A lateral observation well was positioned approximately 225 ft away from the nearest two stimulated and producing horizontal wells. Using optical fiber and Raleigh frequency-shift distributed strain sensing (RFS-DSS), strain change was measured in the far field as the offset well was stimulated and first produced. RFS-DSS provides a spatial resolution of 20 cm, allowing for the monitoring of strain changes at finer spatial resolution than can be sensed accurately with low-frequency distributed acoustic sensing. The strain change during the interference test correlated with both the strain change during the crosswell refracturing monitoring and the pressure-gauge change along the monitor well during the interference test. The strong correlation between crosswell refracturing and interference strain monitoring suggests that the magnitude of crosswell strain responses is directly proportional to the intensity of strain change when the offsetting wells are put online. The comparison of data recorded from RFS-DSS and six reservoir-sensing pressure gauges displayed a strong correlation between the total strain change and total pressure drawdown. Three gauges positioned in regions of large negative strain change during first production, interpreted as drawdown, showed large pressure declines; the other three gauges, positioned in areas of small strain change, saw small pressure declines. The correlation was applied to the total length of the wellbore based on the strain change to estimate a pressure along the entire lateral, including areas without pressure gauges. Pilot Design Located in DeWitt County, Texas, the project consisted of a combination of production infill wells (12H and 13H), pre-existing primary wells (2H, 4H, 6H, and 8H), liner refracturing wells (3H and 5H) and one unstimulated observation well (14H). The wells are landed in the lower Eagle Ford formation. While drilling the observation lateral, horizontal core was collected and used to investigate the frequency of hydraulic and propped fractures created from the 4H and 5H original stimulations. The 14H lateral was equipped with permanent optical fiber, one internal pressure-sensing gauge used for sealed wellbore pressure monitoring, and nine reservoir-sensing pressure gauges to monitor fracture interactions and pressure drawdown from the offset wells. Three of the gauges failed to show connection to the reservoir and were discarded for this analysis.