Secondary Fracture Research Articles

The Association of Prior Fragility Fractures on 8-Year Periprosthetic Fracture Risk Following Total Hip Arthroplasty

BackgroundFragility fractures are often the initial clinical presentation of osteoporosis. Patients who have a history of fragility fractures undergoing total hip arthroplasty (THA) have an increased risk of 2-year postoperative complications. However, the association of recent fragility fractures with complications beyond 2 years following THA remains unknown. The purpose of this study was to characterize the association of prior fragility fractures with 8-year risks of revision THA, periprosthetic fracture (PPF), and secondary fragility fracture. MethodsPatients aged 50 years and more who underwent THA for osteoarthritis were identified in a large national database. Patients were stratified based on whether they sustained a fragility fracture within 3 years prior to THA. There were 18,529 patients who had a prior fragility fracture and 408,753 who did not have a prior fragility fracture. Demographics and comorbidities were collected. Kaplan-Meier and Cox Proportional Hazards analyses were used to observe the cumulative incidences of all-cause revision, PPF, and secondary fragility fracture within 8 years of index surgery. ResultsPatients who had recent fragility fracture had significantly higher risks of revision THA (Hazard Ratio [HR] 1.7; P < .001), PPF (HR 2.2; P < .001), and secondary fragility fracture (HR 4.9; P < .001). ConclusionPrior fragility fracture was shown to be a significant risk factor for revision THA, PPF, and secondary fragility fracture within 8 years of THA. Identification of these high-risk patients with an emphasis on preoperative and postoperative bone health optimization may help minimize these complications.

Hydrodynamic release of Pb, Zn, and Cd from impermeable tailings as deduced from physical parameters evolution and multivariate statistical analysis: case study of Jbel Ressas mine waste (North Tunisia)

Tailings are one of the largest pollutant sources in the world. The wind and water leaching were often considered the main distribution tool of their pollutants. However, the carbonate crust precipitation has negated the trace toxic element (TTE) release. To identify the release mode of Pb, Zn, and Cd from mine wastes, the hydrodynamic evolution of waste piles was considered. The macroscopic and microscopic observation, the grain sizes, cohesion particles, density, hydraulic conductivity, and Pb, Zn, and Cd concentrations performed from eight drill cores of the two waste dumps and the principal component and the hierarchical cluster analysis showed that the physical properties of waste piles closely controlled the TTE mobility and migration from the tailings. The obtained data also showed that the upper carbonate layers were first eroded by wind and rainfall. Then, the formation of an impermeable carbonate crust limited the Pb, Zn, and Cd releases. However, the hydrodynamic evolution of the underneath layers was different. As the high pile waste sediments' weight meaning the lithostatic pressure (Pl), the geostatic ratios (λ = Pf/Pl) were in DII and DIII dumps superior to 0.29 and 0.26, respectively. Therefore, the overpressured fluids increased the mineral dissolution, including the sulfides and carbonates of metals, and hydraulic fracturing that raised the percentages of the mobile TTE and migration indexes. By the secondary pore and fracture volumes, the polluted fluids were progressively channeled towards the underpressured marge (dumps edge) by repetitive (polyphase) fluid pulsations.

Tight gas accumulation caused by overpressure: Insights from three-dimensional seismic data in the western Sichuan Basin, southwest China

Tight gas is an important unconventional gas resource, but numerous aspects of its accumulation and the distribution of high-quality reservoirs remain unclear. The Mesozoic–Cainozoic strata in the Sichuan Basin in southwest China are a focus for tight gas exploration, but have a complex pore pressure distribution that makes exploration challenging. In this study, the pore pressure in Upper Triassic and Jurassic strata in the West Sichuan Depression was predicted from three-dimensional seismic data using the Fillippone method. The results indicate that overpressure has developed in the Upper Triassic Xujiahe Formation in the Xinchang Structural Belt, with pressure coefficients of 1.2–2.4, which are highest in the third member, moderate in the fourth and fifth members, and lowest in the second member. Faults have a significant effect on the pore pressure. Overpressure along regional primary faults is typically weak, but it increases with distance from the faults. The overpressure resulted from disequilibrium compaction and hydrocarbon generation during the Mesozoic, and was intensified and modified by the Himalayan Orogeny. We infer that differential overpressure in tight sandstones is a key factor in gas migration and accumulation. Weakly overpressured zones along primary faults are dominant gas accumulation zones. Secondary faults and related fractures have a limited effect on overpressure, but improve the physical properties of reservoirs by increasing the permeability and promoting water–rock interactions. We suggest that the areas with relatively low pressure around faults and fractures are the most favourable targets for hydrocarbon exploration in tight sandstones.

Microstructure-Based Failure Mechanisms Encountered During Fracture Cutting of Age-Varying Bovine Cortical Bone

Abstract This article aims to investigate the characteristic microstructure-based failure mechanisms observed during the fracture cutting of age-varying bovine cortical bone. To this end, orthogonal cutting experiments are performed on cortical femoral bones harvested from three distinct bovine age groups, viz., young (∼1 month), mature (16–18 months), and old (∼30 months). Fracture cutting is induced at a depth of cut of 70 μm and a cutting velocity of 800 mm/min by using two distinct tool rake angles of +20 deg and 0 deg. The nanoindentation studies and porosity analysis show key differences between microstructural constituents, as a function of age. The high-speed camera images taken during the fracture cutting process provide insight into six dominant microstructure-specific failure mechanisms. These include primary osteonal fracture, woven fracture, and lamellar fracture observed in the plexiform region; and cement line fracture (i.e., osteon debonding), secondary osteonal fracture, and interstitial matrix fracture observed in the haversian regions. In addition to the conventionally reported specific cutting energy metric, a new metric of resultant cutting force per unit crack area and surface integrity are employed here. All cutting responses are seen to be sensitive to age-related microstructural variations and the tool rake angle. In addition to requiring more cutting force, the neutral tool rake angle also results in notable subsurface damage.

Characteristics of forearm refracture in adolescents.

The purpose of this study was to evaluate characteristics of reinjury following forearm fractures in adolescents. An Institutional Review Board-approved retrospective cohort study of forearm fractures (ages 10-18 years) treated by a single academic pediatric orthopaedic group from June 2009 to May 2020 was conducted. All both bone forearm (BBFA) and radius or ulna primary and secondary injuries were included. We excluded open, surgically treated, physeal, epiphyseal, and radial head/neck fractures. Demographics, injury characteristics, and radiographic data were recorded. We evaluated associations of ipsilateral same-site refracture (RE-FRACTURE) versus ipsilateral or contralateral different-site forearm fractures occurring as secondary later injuries (OTHER). Thirty-three of 719 patients sustained a secondary forearm fracture (4.6%; mean age, 11.5 years; M:F, 5.6:1). RE-FRACTURES, compared with OTHER forearm locations, were associated with a sports mechanism at time of original injury ( P = 0.024) and mid-shaft position of fracture on the radius (77.6 vs. 29.8 mm from distal physis; P < 0.001) and ulna (72.0 vs. 27.2 mm from distal physis; P = 0.003). RE-FRACTURES also demonstrated increased radius to ulna distance between BBFA primary injury sites on anteroposterior (19.6 vs. 10.6 mm; P = 0.009) and lateral radiographs (19.6 vs. 10.5 mm; P = 0.020) compared with OTHER forearm locations. Residual angulation and fracture-line visibility were not significantly associated with secondary fracture. Ipsilateral same-site refractures tend to occur in adolescents within 1 year following treatment for widely spaced (>15 mm) and mid-shaft forearm fractures incurred during athletic activity. Further research may be warranted to evaluate biologic, bone health, or personality traits that may lead to secondary fractures of the pediatric forearm.

The effect of fracture recency on observed 5-year fracture probability: A study based on the FRISBEE cohort

IntroductionPrediction models, especially the FRAX®, are largely used to estimate the fracture risk at ten years, but the current algorithm does not take into account the time elapsed after a fracture. Kanis et al. recently proposed correction factors allowing to adjust the FRAX® score for fracture recency. The objective of this work was to analyze the effect of fracture recency in the FRISBEE cohort. MethodsWe identified in the FRISBEE cohort subjects who sustained a validated fracture during the first 5 years following an incident MOF. We calculated their estimated 5-year risk of fracture using FRAX® uncorrected, adjusted for recency and further adjusted for the MOF/hip ratios calibration factors previously derived for the Belgian FRAX®. We compared the fracture risk estimated by FRAX® before and after these corrections to the observed incidence of validated fractures in our cohort. ResultsIn our ongoing cohort, 376 subjects had a first non-traumatic incident validated MOF after inclusion; 81 had a secondary fracture during the 5 years follow-up period after this index fracture. The FRAX® score significantly under-evaluated the observed incidence of fractures in our cohort by 54.7 % (fracture rate of 9.7 %; 95 % CI, 6.8–12.9 %) if uncorrected (p < 0.001) and by 32.6 % after correction for recency (14.5 %; 95 % CI, 11.1–18.2 %) (p = 0.01). The calibration for MOF/hip ratios improved the prediction (17.5 %; 95 % CI: 13.7–21.4 %) (p = 0.2). After correcting for recency and for calibration, the predicted value was over-evaluated by 22 % (fracture rate of 26.1 %; 95 % CI, 21.6–30.5 %) but this over-evaluation was not significant (p = 0.1). ConclusionOur data indicate that the correction of the FRAX® score for fracture recency improves fracture prediction. However, correction for calibration and recency tends to overestimate fracture risk in this population of elderly women.

Experimental Study of the Dynamic Mechanical Behavior and Degradation Mechanism of Red Sandstone in Acid Dry-Wet Cycles

In this paper, the slit Hopkinson pressure bar (SHPB) experiments were conducted to investigate the dynamic mechanical characteristics of red sandstone during acid dry-wet cycles. The appearance of the samples was evaluated using scanning electron microscopy, and the process of red sandstone degradation under acid dry-wet cycles was examined. The results reveal that, as compared to neutral solution, acid solution enhances the degree of degradation induced by dry-wet cycles in red sandstone. The dynamic compressive strength and elastic modulus of red sandstone steadily decline as the number of dry-wet cycles increases, and the lower the pH of solution, the greater the reduction. The mechanism of degradation of red sandstone during acid dry-wet cycles may be explained in two ways. First, the chemical interaction between the mineral components in the sample, such as cement and feldspar, and H+ in the acid solution has accelerated the formation of secondary pores and fractures, resulting in a decrease in the cementation capacity between mineral particles. Second, partial breakdown of the major mineral particles softens the mineral skeleton.

Three‐Dimensional Thermoporoelastic Modeling of Hydrofracturing and Fluid Circulation in Hot Dry Rock

AbstractGeothermal energy, featured as a renewable low‐carbon energy resource, exhibits great potential in mitigating global warming. However, efficient mining of geothermal energy from hot dry rock remains challenging due to the lack of a thermoporoelastic modeling approach that allows for integrated simulation of hydrofracturing and fluid circulation, and poor understanding of the mechanisms of hydraulic stimulations. To conquer these challenges, we propose an advanced modeling approach, which enables us to deal with the interplay between fluid transport, heat transfer, rock deformation, and three‐dimensional fractures' growth and interaction. Based on the thermoporoelastic model, a refined investigation is performed to determine the hydrofracturing and fluid circulation processes, using data collected from the EGS Collab Experiment 1. This meso‐scale testbed involves creating major hydraulic fractures, accompanied by numerous secondary hydroshearing fractures, hydraulically connecting two horizontal wellbores to build a fluid circulation system. All wellbores in the testbed were heavily instrumented with monitoring devices, offering high‐quality data to properly constrain the geomechanical model. Our study provides insights into: (a) how the EGS Collab testbed responds to propagating fractures with strong stress shadowing and long‐term injection of chilled water; (b) why the parallel pattern of two hydraulic fractures with a distance much smaller than the fracture dimension forms during multi‐staged hydraulic stimulations; and (c) what the mechanisms are that determine hydrofracturing performance. Overall, this work not only contributes to a novel modeling approach for integrated simulation of hydrofracturing and fluid circulation, but advances our understanding of creating enhanced geothermal systems with interconnected fracture networks.

Implementation and operationalization of Integrated People-Centred Health Services delivery strategies in integrated osteoporosis care (IOC) initiatives: a systematic review.

Integrated Osteoporosis Care (IOC) has been emerging over the past decade. To support integrated careinitiatives, the World Health Organisation (WHO) has developed the Integrated People Centred Health Services(IPCHS) framework, which consists of five interdependent strategies. Five electronic databases (PubMed, Embase, World of Science, CINAHL, and Scopus) were searched for relevant studies published from January 1, 2010 to December 2022. Initiatives implementing collaborative practices and at least two IPCHS strategies were included. Quality assessment was performed using the Effective Public Health Practice Project checklist. Seventy-six publications describing 69 implementations met the inclusion criteria; 90% of them were implemented at the hospital level, and over half focused on secondary fracture prevention. Three implementations captured all five IPCHS strategies, and half applied three. Substrategies targeting individuals as beneficiaries were frequently employed. Substrategies requiring fundamental shifts (e.g., systemic coordination and updating) were seldomly implemented. Substantive heterogeneity in substrategy operationalization was observed. Patient education, standardized care, team-based care, care coordinators, and health care provider training were commonly pursued. IOC interventions have focused mainly on secondary fracture prevention in a hospital setting and have been narrowly operationalized. Future implementation should: employ all five IPCHS strategies; better align programmes, providers, and regulatory frameworks, while adapting funding mechanisms; and operationalize broader and more innovative substrategies.Registration: This review has been registered at the international prospective register of systematic reviews PROSPERO (CRD42021250244).

Increased Risk of Periprosthetic Fractures and Revision Arthroplasty in Patients Undergoing Shoulder Arthroplasty With a History of Prior Fragility Fractures: A Matched Cohort Analysis.

As rates of anatomic and reverse total shoulder arthroplasty (SA) continue to grow, an increase in the number of osteoporotic patients undergoing SA, including those who have sustained prior fragility fractures, is expected. The purpose of this study was to examine short-term, implant-related complication rates and secondary fragility fractures after SA in patients with and without a history of fragility fractures. A propensity score-matched retrospective cohort study was done using the PearlDiver database to characterize the effect of antecedent fragility fractures in short-term complications after SA. Rates of revision SA, periprosthetic fractures, infection, and postoperative fragility fractures were evaluated using multivariate logistic regression analysis. Risks of these complications were also studied in patients with and without preoperative osteoporosis treatment. Statistical significance was set at P < 0.05. A total of 91,212 SA patients were identified, with 13,050 (14.3%) experiencing a fragility fracture within the 3 years before SA. Two years after SA, there were increased odds of periprosthetic fracture (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.68 to 2.99), fragility fracture (OR 9.11, 95% CI 8.43 to 9.85), deep infection (OR 1.68, 95% CI 1.34 to 2.12), and all-cause revision SA (OR 1.68, 95% CI 1.44 to 1.96) within those patients who had experienced a fragility fracture within 3 years before their SA. Patients who were treated for osteoporosis with bisphosphonates and/or vitamin D supplementation before their SA had similar rates of postoperative periprosthetic fractures, fragility fractures, and all-cause revision SA to those who did not receive pharmacologic treatment. Sustaining a fragility fracture before SA portends substantial postoperative risk of periprosthetic fractures, infection, subsequent fragility fractures, and all-cause revision SA at the 2-year postoperative period. Pharmacotherapy did not markedly decrease the rate of these complications. These results are important for surgeons counseling patients who have experienced prior fragility fractures on the risks of SA.

Patient-Specific Orbital Implants Vs. Pre-Formed Implants for Internal Orbital Reconstruction

ABSTRACT Purpose To compare the outcome of orbital blowout fracture repair by means of pre-formed porous-polyethylene titanium implants (PFI) vs patient-specific porous-polyethylene implants (PSI). Methods Retrospective cohort study. Baseline characteristics, ophthalmic examination results, ocular motility, fracture type, the timing of surgery, implant type, and final relative enophthalmos of all patients operated on for blow-out fractures in a single center were collected and analyzed. Results Twenty-seven patients (mean age 39 years, 9 females) were enrolled. Sixteen underwent fracture repair with PFI and 11 with PSI at 11 months (median) post-trauma. Mean follow-up duration was 1.1 years. Both groups showed significant postoperative improvement in primary or vertical gaze diplopia (P = .03, χ2). Relative enophthalmos improved from −3.2 preoperative PFI to −1.7 mm postoperative PFI, and from −3.0 mm preoperative PSI to −1.1 mm postoperative PSI (P= .1). PSI patients had non-significantly less postoperative enophthalmos and globe asymmetry than PFI patients. The outcome was not influenced by previous surgery, age, sex, number of orbital walls involved in the initial trauma, or medial wall involvement (linear regression). Both groups sustained complications unrelated to implant choice. Conclusion Both PSI and PFI yielded good outcomes in this study. PSI may be a good alternative to PFI in primary or secondary orbital blowout fracture repair with less enophthalmos and globe asymmetry, in spite of the possible disadvantages of production time, a relatively larger design, and challenging insertion. Since it is a mirror image of the uninjured orbit, it may be beneficial in extensive fractures.

Cost Effectiveness of Denosumab for Secondary Prevention of Osteoporotic Fractures Among Postmenopausal Women in China: An Individual-Level Simulation Analysis.

This study evaluated the cost effectiveness of denosumab versus alendronate for secondary prevention of osteoporotic fractures among post-menopausal women in China. A validated individual-level simulation model of osteoporotic fractures in the Chinese setting was adapted. Allowing both treatment discontinuation and waning effects, the analysis aimed to evaluate the incremental cost-effectiveness ratio of denosumab compared to alendronate by simulating a cohort of previously fractured individuals over the residual lifetime from the healthcare system perspective. Hip, vertebral, and wrist/humeral fractures were tracked along with the associated medical costs and quality-adjusted life-years. Age-related health state utility values, health state utility values of fractures, costs, fracture incidence, and mortality risks for Chinese were used whenever available. Comparative effectiveness data were obtained from a published network meta-analysis. One-way and probabilistic sensitivity analyses were conducted. In the base case, denosumab was dominated by alendronate with incremental costs of CN¥2743 (US$425) and incremental health outcomes of -0.20 quality-adjusted life-years at its current price in mainland China. It remained dominated in all one-way sensitivity analysis robustness checks. However, denosumab was cost effective if both drugs did not carry any waning effects. In the probabilistic sensitivity analysis, denosumab remained dominated in all replications. Denosumab is not cost effective for preventing secondary fractures among overall postmenopausal women in China. It is advisable to identify alternative denosumab regimens for high-risk subgroups among previously fractured postmenopausal women.

Effectiveness and prognostic factors of different minimally invasive surgeries for vertebral compression fractures

BackgroundThe aging of China's population has led to an increase in the incidence rate of osteoporosis, which indirectly increases the risk of OVCF in osteoporosis patients. Low back pain is the main symptom of OVCF, and severe patients can further develop kyphosis. Although the conservative treatment of OVCF can effectively control the patient's condition, long-term bed rest will increase the risk of OVCF complications. Minimally invasive surgery is a common solution for OVCF.Methods100 OVCF patients admitted to our hospital from January 2021 to January 2022 are selected for analysis and randomly divided into PVP group and PKP group, 50 cases in each group. The PVP group and the PKP group undergo PVP and PKP operations respectively. The differences in efficacy indicators and adverse reactions are compared, and the multivariate Logistic regression method is used to analyze the influencing factors of postoperative secondary fractures in patients with vertebral compression fractures.ResultsCompared with the PVP group, the total effective rate of PKP group is significantly increased, and the VAS, ODI score, kyphotic Cobb Angle, lateral distribution rate of bone cement and bone cement leakage rate are significantly decreased (P < 0.05). Age ≥ 80 years old, female, glucocorticoid use, lateral distribution of bone cement and bone cement leakage are significantly higher in the proportion of secondary fractures and are independent risk factors for postoperative secondary fractures in patients with OVCF.ConclusionPKP surgery has a higher efficacy in the treatment of OVCF patients, which can reduce the incidence of pain, adverse reactions and promote the recovery of kyphotic Cobb Angle. PKP surgery has a higher value in the treatment of OVCF. In addition, the influencing factors of secondary fracture after minimally invasive surgery in OVCF patients include age, gender, glucocorticoid use, bone cement distribution pattern, bone cement leakage, etc.

Effects of distribution of bone cement on clinical efficacy and secondary fracture after percutaneous kyphoplasty for osteoporotic vertebral compression fractures.

To investigate the effect of bilateral bone cement distribution on the clinical efficacy of percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fracture (OVCF). According to strict inclusion and exclusion criteria, 109 cases of OVCF patients treated with bipedicular PKP were included in this study from August 2018 to July 2020. According to the distribution morphology of bilateral bone cement in vertebral body, patients were divided into 3 groups, including Group A (n = 44): bilateral diffuse type; Group B (n = 31): bilateral dense type; Group C (n = 34): mixed type. To assess the clinical and radiographic efficacy of the surgery, the visual analogue scale (VAS) score, Oswestry disability index (ODI) score, anterior vertebral height (AVH), anterior vertebral height ratio (AVHR) and local kyphotic angle (LKA) were recorded at preoperatively, 2 days after surgery and 1 year after surgery. Compared with the preoperative recorded value, the VAS score, ODI score, AVH, AVHR and LKA of the three groups were significantly improved at 2 days after surgery and 1 year after surgery (p < 0.05). At 1 year after surgery, the VAS score of Group A was better than that of groups B and C (p < 0.05), and there were significantly differences in ODI score, AVH, and LKA between Group A and Group B (p < 0.05). Compared with other bone cement distribution patterns, the incidence of recompression in bilateral diffuse bone cement distribution pattern was lower (p < 0.05). In the mid-term follow-up of patients undergoing bipedicular PKP, diffuse and symmetrical distribution of bone cement can obtain better clinical improvement and lower the incidence of secondary compression.

Multidisciplinary approach to management of osteoporosis with osteoporosis liaison service (OLS).

The prevalence of osteoporosis has increased in super-aging societies. To prevent subsequent fractures from occurring after initial osteoporotic fracture, coordinator-based systems called fracture liaison service (FLS) have been implemented worldwide. In Japan, the osteoporosis liaison service (OLS) including FLS was launched in 2011 in order to reduce the incidence of both primary and secondary fractures in osteoporosis patients. Multidisciplinary management by an OLS coordinator aims to support patient care, monitor medicine adherence, and improve quality of life of the elderly. A framework such as OLS-7 has been proposed to provide comprehensive support regardless of the expertise of each medical staff.

Vertebral compression fracture detection using imitation learning, patch based convolutional neural networks and majority voting

Vertebral compression fractures often go clinically undetected and consequently untreated, resulting in severe secondary fractures due to osteoporosis, and potentially leading to permanent disability or even death. Automated detection of vertebral compression fractures (VCF) could assist in routine screening and followup of incidentally scanned patients, thereby mitigating secondary fractures later. A novel fully automated method for the detection of VCF in 3D computed tomography (CT) of the chest or abdomen is presented in this work. It starts with 3D localisation of thoracic and lumbar spine regions using deep reinforcement learning (DRL) and imitation learning (IL). Six different 3D bounding boxes are generated by the localisation step, achieving an average Jaccard Index (JI)/ Dice Coefficient (DC) of 74.21%/84.71%, and detection accuracy of 97.16 % using 3 different CNN architectures. The localised region is then split into 2D sagittal slices around the coronal centre. Each slice is further divided into patches, on which convolutional neural networks (CNNs) are trained to detect VCF. Four different CNN architectures, namely 3 layered, 6 layered and transfer learning (TL) using VGG16 and ResNet50, were experimented with. The best performing architecture turned out to be the 6 layered CNN. Aggregation is performed on the VCF detection in the 2D Patches extracted from individual bounding boxes, followed by majority voting to arrive at the final decision on the status of VCF for a given patient. An average three-fold cross validation accuracy of 85.95%, sensitivity of 88.10%, specificity of 84.20% and F1 score of 85.94% were achieved on chest images using 6 layered CNN on chest images from 308 patients. An average five-fold cross validation accuracy of 86.67%, sensitivity of 88.13%, specificity of 85.02% and F1 Score of 87.04% were achieved on abdomen images from 168 patients with the 6 layered CNN.

Brittle bones

The use of corticosteroids is common in our clinical practice. Cortico-induced osteoporosis should be taken into consideration when using a dosage higher than 7.5 mg/d of prednisone or equivalent for a minimum of 3 months. We describe the case of a 69-year-old female patient who received long-term corticosteroid treatment for low back pain and developed secondary vertebral compression fractures. This case illustrates the importance of assessing fracture risk when prescribing corticosteroids, in order to offer preventive measures and introduce (in subjects with high risk) prophylactic treatments aiming to reduce the risk of irreversible consequences.

Longevity of composite restorations is definitely not only about materials.

This review study provides an overview of factors that influence the longevity of all types of direct resin composite restorations. A systematic search was performed in PubMed, Scopus, and Web of Science databases for articles reporting data from primary longitudinal clinical studies on composite longevity published 2011-2021. Prospective or retrospective studies with restorations in permanent dentition, with follow-up periods of at least 5 years were included. In total, 33 articles were included with different study designs, practice settings, datasets, countries of origin, and sample sizes. Annual failure rates of restorations ranged from 0.08% to 6.3%. Survival rates varied between 23% and 97.7%, success rates varied between 43.4% and 98.7%. Secondary caries, fractures, and esthetic compromise were main reasons for failures. Risk factors for reduced restoration durability included patient-level factors (e.g., caries risk, parafunctional habits, number of check-ups per year, socioeconomic status), dentist factors (different operators, operator's experience), and tooth/restoration factors (endodontic treatment, type of tooth, number of restored surfaces). Patient gender and the composite used generally did not influence durability. A number of risk factors are involved in the longevity of composite restorations. Differences between composites play a minor role in durability, assuming that materials and techniques are properly applied by dentists. Patient factors play a major role in longevity. The decision-making process implemented by dentists relative to the diagnosis of aging or failed restorations may also affect the longevity of restorations. Clinicians should treat patients comprehensively and promote a healthy lifestyle to ensure longevity.

The role of hydrogen in the corrosion-induced reduction of KR critical fracture toughness and intergranular secondary cracking in a high-strength aluminium alloy

It is shown that short-term exposure of AA2024-T3 material to an exfoliation corrosion (EXCO) solution leads to a reduction of non-plane strain fracture toughness and the formation of secondary surface cracks during plastic straining. The study aims to establish whether the secondary cracking effect and the fracture toughness reduction are due to corrosion-induced hydrogen embrittlement. It is hypothesized that, if hydrogen-embrittlement is the cause of the intergranular secondary cracking (ISC) and fracture toughness degradation, post-exposure heat treatment would restore the mechanical property degradation and reduce the ISC formation through the desorption of diffusible hydrogen. It was found that the solution and ageing heat treatments restored the fracture toughness of the alloy. However, the ISC behaviour persisted. The results are discussed and interpreted in terms of hydrogen embrittlement theory.

Use of Clinical Practice Guidelines and Quality Metrics to Assess Primary Care Management of Osteoporosis.

Background: Clinical practice guidelines and quality measures provide recommendations for physicians addressing osteoporosis management. This study explored the alignment of osteoporosis clinical practice in a primary care geriatric clinic with recommended guidelines. Methods: This retrospective chart review included 388 patients 65 or older from a primary care geriatric clinic diagnosed with osteopenia or osteoporosis, with or without a fragility fracture. Data included history of falls and use of DXA scans, FRAX® fracture risk assessment tool, osteoporosis medication, and fall risk mitigation plans. Results: For age-related primary fracture prevention, 68% of women and 87% of men had documented DXA scans, and 45% of patients diagnosed with osteoporosis and 42% determined at high risk were prescribed osteoporosis medication. For secondary fracture prevention, 72% of women aged 67 to 85 had DXA scans and 21% were prescribed osteoporosis medication. Only 10% of patients with a history of falls had documented fall risk management plans. Conclusion: Although showing higher rates of primary and secondary prevention outcomes than did research results from general primary care, gaps were identified for high fracture risk patients and fall risk management documentation. Medical record review may not provide sufficient data to capture factors influencing decision-making for fracture prevention.