Indirect Fractures Research Articles

Gunshot trauma in human long bones: towards practical diagnostic guidance for forensic anthropologists.

In contrast to cranial gunshot trauma, diagnosis and interpretation of gunshot trauma to long bones remains difficult and controversial. The aim of this study is to review the published literature on fracture patterns resulting from gunshot trauma in human long bones, and to use the described characteristics to provide practical guidance for the forensic anthropologist. In order to achieve this, medical and forensic publications on this topic were reviewed. Several types of fractures, such as linear, oblique, comminuted and butterfly fractures, have been observed in either the shaft or the ends of long bones. Indirect fractures that are not caused by bullets striking bone directly but by bullet-induced forces to the surrounding soft tissue have been found as well. Some of these fractures are related to a specific context or mechanism which might help in the forensic reconstruction of events. It is recommended that future research should focus on available medical data to provide more detailed descriptions on fracture patterns for forensic purposes. Experimentation with bone surrogates and computer modelling might also provide better and more realistic reconstructions of gunshot trauma in the future and provide valuable insights for its diagnosis and interpretation in forensic anthropology.

Optimization of Indirect Fracturing Process Parameters Based on Mechanical Properties of Fractured and Low-Permeability Coal

The coal-bed methane (CBM) resources in soft and low-permeability coals are assumed to be as much as 15 × 1012 m3 in China. Indirect fracturing technology can be an effective method to successfully extract methane within soft coals. The key to the success of this technique is to optimize the parameters, such as water injection flow rate and fracture initiation location, so that the hydraulic fracturing parameters enable the fractures to pass through the interface between coal and rock and propagate sufficiently into the coal. This paper focuses on solving the above problems by focusing on discontinuities and plastic characteristics of soft coals. Voronoi polyhedron was used to simulate the discontinuities of coal, and the constitutive relations of ductile fracture-seepage and elastoplastic damage-seepage are, respectively, given to the discontinuities and coal matrix. A numerical model was established based on the above theory to simulate the effect of stress difference Δσ, coal-rock interface friction coefficient fc,r, water injection flow rate i w , and distance between the well and the interface Dop on indirect fracturing fractures. The results show that the HFs area in the coal is positively correlated with Δσ, fc,r, and i w , and it first increases and then decreases with the decrease of Dop. The above results were applied in the Zhaozhuang mine of Qinshui Basin by optimizing Dop = 1 m and iw = 8 m3/min, so that CBM production has been greatly increased. The results can provide theoretical support for the efficient development of CBM in fractured and low-permeability coal seam areas.

Functional outcome of tension band wiring in transverse patella fracture

Background: Patellar fractures constitute about 1% of all skeletal injuries resulting from either direct or indirect trauma. The subcutaneous nature of the patella makes it vulnerable to direct trauma, whereas violent contraction of the quadriceps results in indirect fractures of the patella. Patella is the largest sesamoid bone in the body and forms an integral part of the extensor mechanism of the knee joint. The functional outcome of patella fractures depends on age, the severity of the injury, treatment modality, anatomical reduction and restoration of articular congruity, post-operative rehabilitation. The study aims to assess the functional outcome of tension band wiring in transverse patella fracture. Materials and Method: This study was carried out at the Department of Orthopaedics, Navodaya Medical College, Raichur over a period of 2 years. In this study, 30 patients (23 male, 7 females) with transverse patella fracture were admitted and were treated by tension band wiring. Functional outcome was assessed as per knee pain score, good fellow grading for a range of motion. Results: A total of thirty patients were evaluated in our study, of which there were 23 males and 7 females. Out of which 24 patients had excellent results, 4 had good results and 2 had fair results. At the end of the 6th month, the majority of patients show excellent results according to good fellow grading range of motion. Conclusion: The tension band wiring is safe and effective in the management of transverse patella fracture because of the good stability of the implant and easier postoperative rehabilitation.

A comparative study of tension band wiring versus circumferential wiring in the management of patellar fractures

Introduction: Patellar fractures constitute about 1% of all skeletal injuries resulting from either direct or indirect trauma. The subcutaneous location of the patella makes it vulnerable to direct trauma, whereas violent contraction of the quadriceps results in indirect fractures of the patella. Any improper and inadequate treatment would inevitably lead to a great deal of disability which would be most perceptibly felt in a country like India, where squatting is an important activity in daily life. Materials and Methods: This prospective study was carried out at the Department of Orthopaedics, KBNIMS, Kalaburagi. In this study, 40 patients(23 males and 17 females; mean age 42.7 years) with Patellar fractures were admitted at Khaja Banda Nawaz Institute of Medical Sciences Hospital, Kalaburagi and examined according to protocol. Associated injuries were noted. Clinical and radiological investigations were carried out to get fitness for surgery. Patients underwent Tension Band Wiring or CircumferentialWiring for the sustained fracture. Patients were followed up at 4 weeks, 8 weeks, 12 weeks till fracture union and once at 1 year after surgery using Reich and Rosenberg criteria. Results: There was no significant difference regarding the mean age, gender, and mechanism of the fractures in patients treated by two methods of TBW and CW. 1 case of superficial infection and 3 cases of joint stiffness were noted after CW and 1 case of superficial infection and 2 cases of joint stiffness had occurred after TBW. 60% excellent, 25% good, 5% fair and 10% poor results were observed after Circumferential Wiring and 65% excellent, 15% good, 15% fair and 5% poor results after TBW. Patients of both groups showed an appreciable and statistically significant improvement in functional outcome at 3 months follow-up period as evidenced by Reich and Rosenberg Criteria that reveals no major difference. Furthermore, the difference in improvement between the two groups was not statistically

Characterising the application of horizontal wells and indirect hydraulic fracturing for improved coal seam gas drainage

Historically, horizontal wells in coal seam gas (CSG) producing areas of Australia have been limited in their ability to stimulate horizontal wellbores with hydraulic fractures, despite most basins being in favourable stress states capable of generating multiple transverse hydraulic fractures. In some cases, overlapping mining tenements limit the ability to effectively deploy steel casing completions to effectively manage multi-stage fracture stimulations along the lateral. In other cases, potential wellbore instabilities preclude the placement of laterals with adequate length to stage numerous fractures required to make a well economic. Strike Energy’s Jaws 1 well indicated well instability when drilling horizontally in the Patchawarra Vu Coal Seam in Petroleum Exploration Licence 96 of the Weena Trough in the Cooper Basin. To overcome this instability, Strike Energy introduced the application of an innovative process of deploying multiple, indirect hydraulic fractures in Jaws 1ST from a horizontal wellbore underlying the coal. Microseismic and surface deformation tiltmeter data acquired during the treatment confirmed the successful placement of fractures in the Patchawarra Vu Coal Seam. Further, chemical tracing and production testing provide further insight into the placement and effectiveness of the overall stimulation. Through analyses of data from the Jaws 1ST, we provide insight and recommendations regarding horizontal well placement to improve indirect hydraulic fracture effectiveness. These recommendations would be applicable for other Australian CSG basins where direct horizontal well drilling and fracture stimulation has been limited (e.g. overlapping mining tenements) or where horizontal well instabilities limit drilling within the seam (i.e. Cooper Basin, depleted coals).

Morphology of direct and indirect rib fractures.

Rib fractures are a common finding in legal medicine and information on the impact mechanism is relevant for trauma reconstruction. This study focuses on morphological characteristics of rib fractures resulting from direct or indirect force. Fresh human ribs (n = 312) were divided into two groups and broken through local force (direct) and bending (indirect) in anterolateral areas. The ribs were macerated, visually investigated and the results statistically analysed. The indirect fractures showed a significant larger lateral offset of the internal and external fracture ends while the fracture ends of the direct fractures were more often straight, in line. Also, the morphology of the inner and outer fracture edges was significantly related to fracture type. Direct fractures mostly had rough and jagged inner edges (tension side) and straight, smooth outer edges (compression side), whereas indirect fractures more often showed the characteristics vice versa. The results were more convincing in combination and in ribs from persons aged ≤ 75years at death. In summary, the direct and indirect rib fractures showed significantly different characteristics regarding orientation and offset of the fracture lines and roughness of the inner and outer fracture edges, which can be helpful to distinguish the traumatizing impact mechanisms in forensic autopsy routine.

Study of patellar fractures treated with modified tension band technique

Introduction: Patella fractures are common and it constitutes about 1% of all skeletal injuries resulting from either direct or indirect trauma. The subcutaneous location of the patella makes it vulnerable to direct trauma as in dashboard injuries or a fall on the flexed knee, whereas violent contraction of the quadriceps results in indirect fractures of patella. These fractures are usually transverse and are associated with tears of medial or lateral retinacular expansions. In this study a series of 30 cases of fracture patella were studied after treating with Modified Tension Band Wiring technique.Methods: This prospective study was done in Department of Orthopaedics at Balaji Institute of surgery research and rehabilitation for the disabled (BIRRD) Hospital, Tirupati, Andhra Pradesh during the period from November 2013 to May 2015 over a period of one and half year. This study consists of 30 cases of fracture patella treated by modified tension band wiring. The cases were selected based on inclusion and exclusion criteria. Inclusion criteria 1.All closed and type I and type IIopen displaced transverse patellar fractures. 2.Transverse fracture with displacement of more than 2 to 3 mm and articular step of more than 2mm. 3.Comminuted fractures where reconstruction and fixation by modified tension band wiring is possible. Exclusion criteria 1.Type III compound fractures. 2.Grossly comminuted, vertical or marginal fractures. 3.Old fractures (more than 2-3 weeks). 4.Pathological fractures. Conclusion: Our study shows that modified tension band wiring is a definitive procedure in management of displaced transverse patellar fracture with least complications and also helps for early mobilization post-operatively. In our study we observed excellent result in 86.6% and good in about 10% and poor in 3.3% of cases. 4 Out of 30 cases had complications. Early post-operative Physiotherapy is a very essential tool of success in the management of these fractures, which helps in reducing complication like stiffness of knee and in providing good function. Long-term follow up is necessary to assess late complications like osteoarthritis and late functional outcome.

An anomalous case of an indirect orbital floor fracture

Fractures of the orbital floor are common in facial trauma. Those that comprise only the orbital floor are called indirect fractures or pure internal orbital floor fractures.We present the case of an indirect fracture of the orbital floor after direct trauma to the back of the head caused by a bicycle accident. To the best of our knowledge this is the first time that this mechanism for such a fracture has been reported.

Clothing increases the risk of indirect ballistic fractures

BackgroundCurrent literature has shown the mechanism of how indirect fractures occur but has not determined what factors increase the risks of such fractures. The objective of this study is thus to determine the effect of clothing and soft tissue thickness on the risk of indirect fracture formation.MethodsTwenty-five fresh red deer femora embedded in ballistic gelatine were shot with varying distances off their medial cortex with a 5.56 × 45 mm North Atlantic Treaty Organization (NATO) bullet while being filmed with a slow-motion video. We compared the effect of two different gelatine depths and the effect of denim cloth laid onto the impact surface of the moulds.ResultsBullet passage in thinner moulds failed to cause fracture because the bullet exited the mould before a large expanding temporary cavity was produced. Clothing dramatically altered the size and depth of the expanding cavity, as well as increased lateral pressures, resulting in more severe fractures with greater bullet distances from the bone that can cause fracture.ConclusionsClothing increases the risk of indirect fracture and results in larger, more superficial temporary cavities, with greater lateral pressures than are seen in unclothed specimens, resulting in more comminuted fractures. Greater tissue depth affords the 5.56 × 45 mm NATO a chance to yaw and thus develop an enlarging temporary cavity that is sufficient to cause fracture.

Ballistic Fractures: Indirect Fracture to Bone

Two mechanisms of injury, the temporary cavity and the sonic wave, have been proposed to produce indirect fractures as a projectile passes nearby in tissue. The purpose of this study is to evaluate the temporal relationship of pressure waves using strain gauge technology and high-speed video to elucidate whether the sonic wave, the temporary cavity, or both are responsible for the formation of indirect fractures. Twenty-eight fresh frozen cadaveric diaphyseal tibia (2) and femurs (26) were implanted into ordnance gelatin blocks. Shots were fired using 9- and 5.56-mm bullets traversing through the gelatin only, passing close to the edge of the bone, but not touching, to produce an indirect fracture. High-speed video of the impact event was collected at 20,000 frames/s. Acquisition of the strain data were synchronized with the video at 20,000 Hz. The exact time of fracture was determined by analyzing and comparing the strain gauge output and video. Twenty-eight shots were fired, 2 with 9-mm bullets and 26 with 5.56-mm bullets. Eight indirect fractures that occurred were of a simple (oblique or wedge) pattern. Comparison of the average distance of the projectile from the bone was 9.68 mm (range, 3-20 mm) for fractured specimens and 15.15 mm (range, 7-28 mm) for nonfractured specimens (Student's t test, p = 0.036). In this study, indirect fractures were produced after passage of the projectile. Thus, the temporary cavity, not the sonic wave, was responsible for the indirect fractures.

Indirect orbital floor fractures: A meta-analysis

Orbit fractures are common in the context of orbital trauma. Fractures of the orbital floor without orbital rim involvement are known as indirect orbital floor fractures, pure internal floor fractures, and orbital blowout fractures. In this paper, we have reported a meta-analysis of orbital floor fractures focusing on indications and timing of surgical repair, outcomes, and complications.

Indirect patella fractures following ACL reconstruction: A review

Indirect patella fractures following ACL reconstruction: A review

Frequency of Laryngeal and Hyoid Bone Trauma in Nonhomicidal Cases Who Died After a Fall From a Height

A retrospective study was carried out on 93 autopsy cases who died after a fall from a height. For each case, following parameters were reported: age, sex, manner of death, estimated height of fall, ground type, estimated site of primary impact, type of laryngeal and hyoid bone trauma, presence of associated local trauma in the neck and cephalic region. Mean age of the studied population was about 33 years. Sex ratio (men/women) was 1.8. Mean height of fall was about 15 m. Manner of death was, respectively, suicide and accident in 70 and 23 cases. The type of ground was concrete in 94% of the cases. The site of primary impact was, respectively, head, front of the body, back of the body, feet/lower limbs, and lateral body in 31, 26, 19, 12, and 5 cases. Cervical soft tissue bruising without laryngohyoid fractures was found in 5 cases. Laryngohyoid fractures were found in 5 cases. These fractures could be explained by direct impact of the neck structures against the ground. The mechanism of these fractures could also be indirect fractures due to high muscle strains on the hyoid bone or thyroid cartilage due to cervical hyperflexion or hyperextension or secondary to mandible or cervical vertebral column fractures.

Indirect patella fractures following ACL reconstruction: A review

The bone-patellar tendon-bone (BTB) graft has been popularized as a suitable graft for anterior cruciate ligament (ACL) reconstructions. Fracture of the donor patella, however, is a potential compl...

Radiologic assessment of maxillofacial, mandibular, and skull base trauma

Cranio-maxillofacial injuries affect a significant proportion of trauma patients either in isolation or concurring with other serious injuries. Contrary to maxillofacial injuries that result from a direct impact, central skull base and lateral skull base (petrous bone) fractures usually are caused by a lateral or sagittal directed force to the skull and therefore are indirect fractures. The traditional strong role of conventional images in patients with isolated trauma to the viscerocranium is decreasing. Spiral multislice CT is progressively replacing the panoramic radiograph, Waters view, and axial films for maxillofacial trauma, and is increasingly being performed in addition to conventional films to detail and classify trauma to the mandible as well. Imaging thus contributes to accurately categorizing mandibular fractures based on location, into alveolar, mandibular proper, and condylar fractures-the last are subdivided into intracapsular and extracapsular fractures. In the midface, CT facilitates attribution of trauma to the categories central, lateral, or combined centrolateral fractures. The last frequently encompass orbital trauma as well. CT is the imaging technique of choice to display the multiplicity of fragments, the degree of dislocation and rotation, or skull base involvement. Transsphenoid skull base fractures are classified into transverse and oblique types; lateral base (temporal bone) trauma is subdivided into longitudinal and transverse fractures. Supplementary MR examinations are required when a cranial nerve palsy occurs in order to recognize neural compression. Early and late complications of trauma related to the orbit, anterior cranial fossa, or lateral skull base due to infection, brain concussion, or herniation require CT to visualize the osseous prerequisites of complications, and MR to define the adjacent brain and soft tissue involvement.

Contamination of ballistic fractures: an in vitro model

This study allowed the development of an in vitro model of a high-energy ballistic fracture. Direct fractures are more heavily contaminated than indirect fractures, and the spread of contamination is more extensive than examination of the wounds, particularly the entry wounds, would suggest. The major spread of contamination is along tissue planes, and we would recommend that these are thoroughly lavaged in the management of the fracture. The fracture site is heavily contaminated, with endosteal spread in direct fractures. However, there appears to be relatively little bony contamination beyond the fracture site.

Injuries to the cervical spine in American football players.

A national registry has documented data on more than 1300 cervical spine injuries resulting from tackle football. Axial loading of the cervical spine is the primary injury mechanism, an observation with profound implications regarding implementation of preventative measures. Characteristic injury patterns involving the middle (third and fourth) cervical segment and the more favorable response to prompt reduction of these injuries are emphasized. The marked instability and grave prognosis of axial load teardrop fractures are attributed to the associated sagittal vertebral body and posterior arch fractures. Spear tackler’s spine is described and is classified as an absolute contraindication to participation in collision sports. Cervical cord neurapraxia, with or without transient quadriplegia, is neither associated with nor presages permanent neurologic sequelae. However, there is a considerable risk of recurrence, which can be predicted on the basis of canal diameter data. The concept of spinal cord resuscitation is proposed as a means of obtaining maximum neurologic recovery by reversing the secondary injury phenomenon that occurs in acute spinal cord trauma. Athletic trauma to the cervical spine resulting in injury to the spinal cord is an infrequent but potentially catastrophic event. Recognition of the problems presented by injury to the cervical spine and spinal cord led to a series of field, clinical, and basic research studies conducted over the past twenty-five years. As a result of these efforts, basic questions have been answered regarding the epidemiology, prevention, pathomechanics, pathophysiology, and histochemical responses of reversible and irreversible cervical cord injuries. Allen et al.1 studied 165 closed indirect fractures and dislocations of the lower cervical spine, demonstrating various “spectra of injuries,” and developed a classification based on the mechanism of injury as determined by the presumed attitude of the cervical spine at the time of failure and the initial dominant mode of failure. The common …

上腕骨小頭骨折の治療経験

Fourteen patients with fractures of the humeral capitellum were treated at the Chugoku Rosai Hospital during a sixteen year period. Eight patients were available for follow up assessment. Conservative treatment was carried out in only one patient.Open reduction and internal fixation were performed in seven patients. Eight patients were assessed for reduction in range of motion, instability and pain. Downgrading because of a reduced range of motion was recorded in six patients. Type II was frequently seen due to indirect fractures in younger patients. In elderly patients Type IQ was frequently seen because of direct fractures. The differences in types was responsible for differences in treatment results.

顎関節突起骨折１２３例の臨床統計的観察

123 mandibular condylar fractures treated at our department from January 1986 to December 1991 were reviewed and analysed.Their characteristics were as follows:1. Condylar fractures occurred in 49. 6% of the mandibular fractures and the male: female ratio was 1.5 to 1. The largest age group of patients was from 15 to below 20 years (24. 4%).2. The most frequent cause of condylar fracture was traffic accidents (51.2%).3. Of 123 cases, 99 (80.5%) were unilateral, 24 (19.5%) were bilateral, and 61 (49.6%) were complicated by other mandibular fractures. The overwhelning majority of cases (95.0%) were indirect fractures.4. Fractures with displacement and/or dislocation occurred most frequently in the condylar superior neck region (22.0%).5. Of 147 condyles, closed reduction for mandibular condylar fracture was performed in 122 (83.0%) condyles and open reduction was perfomed in 25 condyles (17.0%).6. As for the clinical results in 106 cases, 91 (86.0%) were completely healed and 15 cases (14.0%) had disorder 1. Results in the patients treated were generally good.

A Mechanistic Classification of Closed, Indirect Fractures and Dislocations of the Lower Cervical Spine

Closed, indirect fractures and dislocations of the lower cervical spine occur in families or groups within which there is a spectrum of anatomic damage to a cervical motion segment. This study of 165 cases demonstrates the various spectra of injury, called phylogenies, and develops a classification based on the mechanism of injury. The common groups are compressive flexion, vertical compression, distractive flexion, compressive extension, distractive extension, and lateral flexion. The probability of an associated neurologic lesion relates directly to the type and severity of cervical spine injury. With use of the classification, it is possible to formulate a rational treatment plan for injuries to the cervical spine.