Complex trimalleolar ankle fractures are a major orthopaedic challenge,with an incidence of 4.22 per 10000 person-years in the United States and an annual cost of 3.4 billion dollars.This review synthesizes current ev...Complex trimalleolar ankle fractures are a major orthopaedic challenge,with an incidence of 4.22 per 10000 person-years in the United States and an annual cost of 3.4 billion dollars.This review synthesizes current evidence on diagnostic protocols and management strategies,highlighting optimal approaches and emerging trends.Initial care emphasizes soft tissue assessment,often guided by the Tscherne classification,and fracture classification systems.External fixation may be required in open injuries,while early open reduction and internal fixation within six days is linked to improved outcomes.Minimally invasive techniques for the lateral malleolus,including intramedullary nailing and locking plates,are effective,while medial malleolus fractures are commonly managed with screw fixation or tension-band wiring.Posterior malleolus fragments involving more than 25%of the articular surface usually warrant fixation.Alternatives to syndesmotic screws,such as cortical buttons or high-strength sutures,reduce the need for secondary procedures.Arthroscopic-assisted open reduction and internal fixation benefits younger,active patients by enabling concurrent management of intra-articular and ligamentous injuries.Postoperative care prioritizes early weight-bearing and validated functional scores.Despite advances,complications remain common,and further research is needed to refine surgical strategies and improve outcomes.展开更多
BACKGROUND Ankle fractures are well-documented in snow sports,but concomitant Achilles tendon and peroneal tendon ruptures are rare.This case report presents a previously unreported combination of Achilles tendon rupt...BACKGROUND Ankle fractures are well-documented in snow sports,but concomitant Achilles tendon and peroneal tendon ruptures are rare.This case report presents a previously unreported combination of Achilles tendon rupture,peroneal tendon rupture,and fibular fracture in a snowboarder,highlighting the complex nature of diagnosis,management,and rehabilitation.CASE SUMMARY A 50-year-old male snowboarder presented with severe right ankle pain following a high speed tumbling crash.Initial evaluation revealed an Achilles tendon rupture and a non-displaced distal lateral malleolus fracture.Subsequent magnetic resonance imaging confirmed complete tears of the Achilles tendon and both peroneus longus and brevis tendons,along with a Weber A lateral malleolus fracture.Surgical intervention included a 4-suture core Kraków repair of the Achilles tendon with calcaneal docking,open reduction and internal fixation of the distal fibula fracture,and primary repair of both peroneal tendons.Postoperatively,a modified Achilles repair protocol was implemented.At 16 weeks post-surgery,radiographs showed a well-healed fibular fracture,and physical examination confirmed intact Achilles and peroneal tendon repairs.By 6 months,the patient had regained full daily and work activities,including recreational pursuits.CONCLUSION This case underscores the importance of maintaining a high index of suspicion for concomitant injuries in high-energy ankle trauma during snow sports.Timely advanced imaging and a comprehensive surgical approach are crucial for optimal outcomes in such complex cases.展开更多
This paper prepared a novel as-cast W-Zr-Ti metallic ESM using high-frequency vacuum induction melting technique.The above ESM performs a typical elastic-brittle material feature and strain rate strengthening behavior...This paper prepared a novel as-cast W-Zr-Ti metallic ESM using high-frequency vacuum induction melting technique.The above ESM performs a typical elastic-brittle material feature and strain rate strengthening behavior.The specimens exhibit violent chemical reaction during the fracture process under the impact loading,and the size distribution of their residual debris follows Rosin-Rammler model.The dynamic fracture toughness is obtained by the fitting of debris length scale,approximately 1.87 MPa·m~(1/2).Microstructure observation on residual debris indicates that the failure process is determined by primary crack propagation under quasi-static compression,while it is affected by multiple cracks propagation in both particle and matrix in the case of dynamic impact.Impact test demonstrates that the novel energetic fragment performs brilliant penetration and combustion effect behind the front target,leading to the effective ignition of fuel tank.For the brittleness of as-cast W-ZrTi ESM,further study conducted bond-based peridynamic(BB-PD)C++computational code to simulate its fracture behavior during penetration.The BB-PD method successfully captured the fracture process and debris cloud formation of the energetic fragment.This paper explores a novel as-cast metallic ESM,and provides an available numerical avenue to the simulation of brittle energetic fragment.展开更多
The Gabes aquifer system,located in southeastern Tunisia,is a crucial resource for supporting local socio-economic activities.Due to its dual porosity structure,is particularly vulnerable to pollution.This study aims ...The Gabes aquifer system,located in southeastern Tunisia,is a crucial resource for supporting local socio-economic activities.Due to its dual porosity structure,is particularly vulnerable to pollution.This study aims to develop a hybrid model that combines the Fracture Aquifer Index(FAI)with the conventional GOD(Groundwater occurrence,Overall lithology,Depth to water table)method,to assess groundwater vulnerability in fractured aquifer.To develop the hybrid model,the classical GOD method was integrated with FAI to produce a single composite index.Each parameter within both GOD and FAI was scored,and a final index was calculated to delineate vulnerable areas.The results show that the study area can be classified into four vulnerability levels:Very low,low,moderate,and high,indicating that approximately 8%of the area exhibits very low vulnerability,29%has low vulnerability,25%falls into the moderate category,and 38%is considered highly vulnerable.The FAI-GOD model further incorporates fracture network characteristics.This refinement reduces the classification to three vulnerability classes:Low,medium,and high.The outcomes demonstrate that 46%of the area is highly vulnerable due to a dense concentration of fractures,while 17%represents an intermediate zone characterized by either shallow or deeper fractures.In contrast,37%corresponds to areas with lightly fractured rock,where the impact on vulnerability is minimal.Multivariate statistical analysis was employed using Principal Components Analysis(PCA)and Hierarchical Cluster Analysis(HCA)on 24 samples across six variables.The first three components account for over 76%of the total variance,reinforcing the significance of fracture dynamics in classifying vulnerability levels.The FAI-GOD model removes the very-low-vulnerability class and expands the spatial extent of low-and high-vulnerability zones,reflecting the dominant influence of fracture networks on aquifer sensitivity.While both indices use a five-class system,FAI-GOD redistributes vulnerability by eliminating very-low-vulnerability areas and amplifying low/high categories,highlighting the critical role of fractures.A strong correlation(R2=0.94)between the GOD and FAI-GOD indices,demonstrated through second-order polynomial regression,confirms the robustness of the FAI-GOD model in accurately predicting vulnerability to pollution.This model provides a useful framework for assessing the vulnerability of complex aquifers and serves as a decision-making tool for groundwater managers in similar areas.展开更多
BACKGROUND Humeral shaft fractures are common and vary by age,with high-energy trauma observed in younger adults and low-impact injuries in older adults.Radial nerve palsy is a frequent complication.Treatment ranges f...BACKGROUND Humeral shaft fractures are common and vary by age,with high-energy trauma observed in younger adults and low-impact injuries in older adults.Radial nerve palsy is a frequent complication.Treatment ranges from nonoperative methods to surgical interventions such as intramedullary K-wires,which promote faster rehabilitation and improved elbow mobility.AIM To evaluate the outcomes of managing humeral shaft fractures using closed reduction and internal fixation with flexible intramedullary K-wires.METHODS This was a retrospective cohort study analyzing the medical records of patients with humeral shaft fractures managed with flexible intramedullary K-wires at King Abdulaziz Medical City,using non-random sampling and descriptive analysis for outcome evaluation.RESULTS This study assessed the clinical outcomes of 20 patients treated for humeral shaft fractures with intramedullary K-wires.Patients were predominantly male(n=16,80%),had an average age of 39.2 years,and a mean body mass index of 29.5 kg/m^(2).The fractures most frequently occurred in the middle third of the humerus(n=14,70%),with oblique fractures being the most common type(n=7,35%).All surgeries used general anesthesia and a posterior approach,with no intraoperative complications reported.Postoperatively,all patients achieved clinical and radiological union(n=20,100%),and the majority(n=13,65%)reached an elbow range of motion from 0 to 150 degrees.CONCLUSION These results suggest that intramedullary K-wire fixation may be an effective option for treating humeral shaft fractures,with favorable outcomes in range of motion recovery,fracture union,and a low rate of intraoperative complications.展开更多
This study investigates the fracture behavior of clay-rich mudstone under varying temperature and pressure conditions,which is crucial for the safety of geological structures.It focuses on three fracture types:pure mo...This study investigates the fracture behavior of clay-rich mudstone under varying temperature and pressure conditions,which is crucial for the safety of geological structures.It focuses on three fracture types:pure mode I tensile fractures,pure mode II tensile fractures,and shear fractures,examining specimens at room temperature(RT)and after thermal treatments at 250 and 500℃.The findings reveal that increasing temperatures makes the mudstone more brittle,enhancing fracture velocity,toughness,load-bearing capacity,roughness,and the fracture process zone(FPZ)radius.Notably,tensile fractures induced under pure mode II displayed the highest velocities,while shear fractures exhibited the lowest velocities,smoothest surfaces,and greatest resistance to failure.The application of a confining pressure of 4 MPa significantly improved shear fracture toughness by 119.7%,98.5%and 71.9%at RT,250℃and 500℃,respectively,and reduced roughness by 8.2%,22.4%and 30.4%.This research offers a novel,comprehensive view of how temperature and pressure impact fractures in mudstone sensitive to temperature due to its high clay content and water affinity.The findings provide valuable insights applicable to geothermal energy,oil and gas exploration,and underground construction,thereby enhancing the understanding of fracture mechanics in geological contexts.展开更多
Prepulse combined hydraulic fracturing facilitates the development of fracture networks by integrating prepulse hydraulic loading with conventional hydraulic fracturing.The formation mechanisms of fracture networks be...Prepulse combined hydraulic fracturing facilitates the development of fracture networks by integrating prepulse hydraulic loading with conventional hydraulic fracturing.The formation mechanisms of fracture networks between hydraulic and pre-existing fractures under different prepulse loading parameters remain unclear.This research investigates the impact of prepulse loading parameters,including the prepulse loading number ratio(C),prepulse loading stress ratio(S),and prepulse loading frequency(f),on the formation of fracture networks between hydraulic and pre-existing fractures,using both experimental and numerical methods.The results suggest that low prepulse loading stress ratios and high prepulse loading number ratios are advantageous loading modes.Multiple hydraulic fractures are generated in the specimen under the advantageous loading modes,facilitating the development of a complex fracture network.Fatigue damage occurs in the specimen at the prepulse loading stage.The high water pressure at the secondary conventional hydraulic fracturing promotes the growth of hydraulic fractures along the damage zones.This allows the hydraulic fractures to propagate deeply and interact with pre-existing fractures.Under advantageous loading conditions,multiple hydraulic fractures can extend to pre-existing fractures,and these hydraulic fractures penetrate or propagate along pre-existing fractures.Especially when the approach angle is large,the damage range in the specimen during the prepulse loading stage increases,resulting in the formation of more hydraulic fractures.展开更多
Fractures are critical control factors in volcanic reservoirs.Thus,studies on the prediction and distribution patterns of volcanic fractures are crucial for oil and gas exploration and development.Although considerabl...Fractures are critical control factors in volcanic reservoirs.Thus,studies on the prediction and distribution patterns of volcanic fractures are crucial for oil and gas exploration and development.Although considerable research has been conducted on volcanic fractures,targeted research on the spatial distribution patterns of fracture development remains limited in the literature.Two eruption modes,subaqueous eruption and subaerial eruption,have been identified in the Chaganhua subsag of the Songliao Basin,where gas resources have been discovered.Studying the differences in volcanic fracture development is highly important for understanding the law of oil and gas enrichment in volcanic reservoirs.On the basis of thin sections,cores,electrical imaging logs,and other data obtained from boreholes of subaqueous volcanic eruptions in the Songnan fault depression,we describe the characteristics of drilled fractures in detail and use 3D seismic data to extract intrinsic coherence,ant bodies,and Fourier series to extend the azimuthal anisotropic P-wave reflection coefficient,thereby predicting the spatial distribution of fractures at different scales.Moreover,through statistical analysis of quantitative evaluation indicators,such as fracture density and fracture development rate in different drilling wells,combined with the spatial distribution patterns of the predicted fractures,we compared and analyzed the relationships between the distributions of fractures and volcanic institutions,lithology,and volcanic facies.Results indicate that fractures are more developed in volcanic edifices located closer to faults.Considerable differences in fracture development are observed among lithofacies of volcanic rocks.Near faults,effusion facies,explosive facies and external clastic pyroclastic sedimentary subfacies are favorable for fracture development.This research provides a reference for investigating volcanic rock fractures of the same origins worldwide.展开更多
This study aims to understand the effect of injection rate on injection-induced fracture activation in granite.We performed water injection-induced slip tests on samples containing either a smooth or a rough fracture ...This study aims to understand the effect of injection rate on injection-induced fracture activation in granite.We performed water injection-induced slip tests on samples containing either a smooth or a rough fracture at four different injection rates under undrained conditions and monitored the acoustic emission(AE)signals during the tests.Experimental results reveal that the critical activation fluid pressure is related to the injection rate,pressure diffusion rate,stress state,and fracture roughness.For the smooth fracture,as the injection rate increases,the critical activation fluid pressure increases significantly,while the injection rate has little effect on the critical activation fluid pressure of the rough fracture.The quasi-static slip distance of fractures decreases as the injection rate increases,with rough fractures exhibiting a greater overall slip distance compared to smooth fractures.The number of AE events per unit sliding distance increases with the injection rate,while the global b value decreases.These results indicate that higher injection rates produce more large-magnitude AE events and more severe slip instability and asperity damage.We established a linkage between fluid injection volume,injection rate,and AE events using the seismogenic index(Σ).The smooth fracture exhibits a steadily increasingΣwith the elapse of injection time,and the rate of increase is higher at higher injection rates;while the rough fracture is featured by a fluctuatingΣ,signifying the intermittent occurrence of large-magnitude AE events associated with the damage of larger fracture asperities.Our results highlight the importance of fracture surface heterogeneity on injection-induced fracture activation and slip.展开更多
In order to identify the development characteristics of fracture network in tight conglomerate reservoir of Mahu after hydraulic fracturing,a hydraulic fracturing test site was set up in the second and third members o...In order to identify the development characteristics of fracture network in tight conglomerate reservoir of Mahu after hydraulic fracturing,a hydraulic fracturing test site was set up in the second and third members of Triassic Baikouquan Formation(T1b2 and T1b3)in Ma-131 well area,which learned from the successful experience of hydraulic fracturing test sites in North America(HFTS-1).Twelve horizontal wells and a high-angle coring well MaJ02 were drilled.The orientation,connection,propagation law and major controlling factors of hydraulic fractures were analyzed by comparing results of CT scans,imaging logs,direct observation of cores from Well MaJ02,and combined with tracer monitoring data.Results indicate that:(1)Two types of fractures have developed by hydraulic fracturing,i.e.tensile fractures and shear fractures.Tensile fractures are approximately parallel to the direction of the maximum horizontal principal stress,and propagate less than 50 m from perforation clusters.Shear fractures are distributed among tensile fractures and mainly in the strike-slip mode due to the induced stress field among tensile fractures,and some of them are in conjugated pairs.Overall,tensile fractures alternate with shear fractures,with shear fractures dominated and activated after tensile ones.(2)Tracer monitoring results indicate that communication between wells was prevalent in the early stage of production,and the static pressure in the fracture gradually decreased and the connectivity between wells reduced as production progressed.(3)Density of hydraulic fractures is mainly affected by the lithology and fracturing parameters,which is smaller in the mudstone than the conglomerate.Larger fracturing scale and smaller cluster spacing lead to a higher fracture density,which are important directions to improve the well productivity.展开更多
Understanding the anisotropic fracture behavior and the characteristics of the fracture process zone(FPZ)under size effects in laminated rocks,as well as its role in rock fracturing,is crucial for various engineering ...Understanding the anisotropic fracture behavior and the characteristics of the fracture process zone(FPZ)under size effects in laminated rocks,as well as its role in rock fracturing,is crucial for various engineering applications.In this study,three-point bending tests were conducted on shale specimens with varying bedding angles and sizes.The anisotropic characteristics and size effects of fracture parameters were revealed.A comparative analysis was performed on the evolutions of FPZs computed using size effect theory,digital image correlation(DIC),and linear elastic fracture mechanics.The results divulged that:(i)With increasing bedding angles,there is a noticeable decrease in apparent fracture toughness(KICA),apparent fracture energy(GICA),and nominal strength(σ_(Nu)).When the bedding angle of shale is less than 45°,the crack propagation and fracture parameters are mainly influenced by the matrix.Contrary,shale with bedding angles greater than 60°,the crack propagation and fracture parameters are mainly controlled by the bedding.When the bedding angle is between 45°and 60°,the fracture propagation evolves from permeating the matrix to extending along the bedding;(ii)The fracture parameters exhibit significant size dependent behavior,as KICA and GICA rise with increasing specimen size,butσNu falls with increasing specimen sizes.The fracture parameters align with the theoretical predictions of Bažant size effect law;and(iii)The lengths of DIC-based FPZ,effective FPZ,and inelastic zone follow W-shape variations with bedding angle.The dimensionless sizes of FPZ and inelastic zone decrease with specimen size,indicating a size effect.Furthermore,there is a negative relation between KICA and the dimensionless size of the FPZ,whileσNu is positively correlated to the dimensionless size of the FPZ.This highlights the essential role of the FPZ in the size effect of rock fracture.The bedding angle exerts an influence on the FPZ,subsequently affecting the anisotropic fracture and size-dependent behavior of shale.展开更多
Accurate prediction of hydraulic fracture propagation is vital for Enhanced Geothermal System(EGS)design.We study the first hydraulic fracturing job at the GR1 well in the Gonghe Basin using field data,where the overa...Accurate prediction of hydraulic fracture propagation is vital for Enhanced Geothermal System(EGS)design.We study the first hydraulic fracturing job at the GR1 well in the Gonghe Basin using field data,where the overall direction of hydraulic fractures does not show a delineated shape parallel to the maximum principal stress orientation.A field-scale numerical model based on the distinct element method is set up to carry out a fully coupled hydromechanical simulation,with the explicit representation of natural fractures via the discrete fracture network(DFN)approach.The effects of injection parameters and in situ stress on hydraulic fracture patterns are then quantitatively assessed.The study reveals that shear-induced deformation primarily governs the fracturing morphology in the GR1 well,driven by smaller injection rates and viscosities that promote massive activation of natural fractures,ultimately dominating the direction of hydraulic fracturing.Furthermore,the increase of in situ differential stress may promote shear damage of natural fracture surfaces,with the exact influence pattern depending on the combination of specific discontinuity properties and in situ stress state.Finally,we provide recommendations for EGS fracturing based on the influence characteristics of multiple parameters.This study can serve as an effective basis and reference for the design and optimization of EGS in the Gonghe basin and other sites.展开更多
Coupled thermo-hydro-mechanical(THM)processes in fractured rock are playing a crucial role in geoscience and geoengineering applications.Diverse and conceptually distinct approaches have emerged over the past decades ...Coupled thermo-hydro-mechanical(THM)processes in fractured rock are playing a crucial role in geoscience and geoengineering applications.Diverse and conceptually distinct approaches have emerged over the past decades in both continuum and discontinuum perspectives leading to significant progress in their comprehending and modeling.This review paper offers an integrated perspective on existing modeling methodologies providing guidance for model selection based on the initial and boundary conditions.By comparing various models,one can better assess the uncertainties in predictions,particularly those related to the conceptual models.The review explores how these methodologies have significantlyenhanced the fundamental understanding of how fractures respond to fluid injection and production,and improved predictive capabilities pertaining to coupled processes within fractured systems.It emphasizes the importance of utilizing advanced computational technologies and thoroughly considering fundamental theories and principles established through past experimental evidence and practical experience.The selection and calibration of model parameters should be based on typical ranges and applied to the specificconditions of applications.The challenges arising from inherent heterogeneity and uncertainties,nonlinear THM coupled processes,scale dependence,and computational limitations in representing fieldscale fractures are discussed.Realizing potential advances on computational capacity calls for methodical conceptualization,mathematical modeling,selection of numerical solution strategies,implementation,and calibration to foster simulation outcomes that intricately reflectthe nuanced complexities of geological phenomena.Future research efforts should focus on innovative approaches to tackle the hurdles and advance the state-of-the-art in this critical fieldof study.展开更多
BACKGROUND Hand in hand with technological advancements,treatment modalities continue to grow.With the turn of the century,the internet has become the number one source of information for almost every topic.Thus,many ...BACKGROUND Hand in hand with technological advancements,treatment modalities continue to grow.With the turn of the century,the internet has become the number one source of information for almost every topic.Thus,many patients look toward the internet as their primary source of information to learn about their respective medical conditions.The American Medical Association and National Institute of Health strongly recommend that online medical information be written at the 6th to 8th-grade level to aid comprehension by patients of all literacy backgrounds.AIM To assess the readability of online information regarding Jones fracture.Our hypothesis is that the reading level of medical information published on websites far exceeds the recommended reading level of 6th-8th grade as proposed by the American Medical Associate and National Institute of Health.The result of this study can help us formulate improved recommendations for publishing more comprehensible material and,thus,eventually improve patient compliance and clinical outcomes.METHODS The exact phrase“Jones fracture”was queried on the three most common search engines,Google,Yahoo!,and Bing,on December 28,2022.As of December 2022,Google held 84%,Bing held 9%,and Yahoo!held 2%of the worldwide search engine market share.Web pages uniform resource locator from the first three pages of search results were recorded from each search engine.These web pages were classified according to academic,physician-sponsored,governmental and non-government organizations(NGO),commercial,and unspecified as per formally defined categories.Websites associated with an educational institution or medical organization were classified as academic.Websites with products for sale,corporate sponsorship,or advertisements were classified as commercial.Governmental websites or NGOs comprised those that received government subsidies or grants.Webpages that were independently owned by physicians or physician groups were respectively classed as physician sponsored.The remainder of websites that did not fall under the above categories were classified as unspecified.RESULTS A total of 93 websites were analyzed for reading assessment.A whopping 44%of websites were commercial,followed by 22%of physician-sponsored websites.Third place belonged to non-government organization websites holding a 15%share.The academic website held a meager 9%portion,while unspecified sites were 3%.The table illustrates mean readability scores,along with average cumulative grade level.The average grade level was 10.95±2.28 for all websites,with a range of 6.18 to 18.90.Since P values were more than 0.05,there was not a significant statistical difference between the first page results and the results of all pages.Thus,we can rationalize that readability scores are consistent throughout all pages of a website.CONCLUSION Hand in hand with technological advancements,treatment modalities continue to grow.With the turn of the century,the internet has become the number one source of information for almost every topic.Thus,many patients look towards the internet as the primary source of information to learn about their respective medical conditions.Our study demonstrates that current online medical information regarding Jones fracture is written at an extraordinarily high-grade level,with an average grade level of all websites at 10.95,nearly an 10th-grade educational level.The American Medical Association and National Institute of Health strongly recommend that online medical information should be written at the 6th to 8th-grade level to aid comprehension by patients of all literacy backgrounds.On the contrary,most of the medical information evaluated was at an 10th-grade level,which far exceeds recommendations by AMA and NIH.This is particularly relevant because readability scores are directly proportional to the level of comprehension attained by readers,thus directly impacting patient outcomes.In conclusion,we suggest and encourage that all online reading materials should be re-written at the 6th to 8th-grade level in a public service effort to increase compliance with treatment goals and raise awareness of preventive measures.展开更多
Pelvic fractures are often caused by high-energy injuries and accompanied by hemodynamic instability.Traditional open surgery has a large amount of bleeding,which is not suitable for patients with acute pelvic fractur...Pelvic fractures are often caused by high-energy injuries and accompanied by hemodynamic instability.Traditional open surgery has a large amount of bleeding,which is not suitable for patients with acute pelvic fracture.Navigationguided,percutaneous puncture-screw implantation has gradually become a preferred procedure due to its advantages,which include less trauma,faster recovery times,and less bleeding.However,due to the complexity of pelvic anatomy,doctors often encounter some problems when using navigation to treat pelvic fractures.This article reviews the indications,contraindications,surgical procedures,and related complications of this procedure for the treatment of sacral fractures,sacroiliac joint injuries,pelvic ring injuries,and acetabular fractures.We also analyze the causes of inaccurate screw placement.Percutaneous screw placement under navigational guidance has the advantages of high accuracy,low incidence of complications and small soft-tissue damage,minimal blood loss,short hospital stays,and quick recovery.There is no difference in the incidence of complications between surgeries performed by new doctors and experienced ones.However,computer navigation technology requires extensive training,and attention should be given to avoid complications such as screw misplacement,intestinal injury,and serious blood vessel and nerve injuries caused by navigational drift.展开更多
BACKGROUND Pubic ramus fractures are generally considered fragility fractures in the elderly population,commonly deriving from a low-impact fall.Treatment is ordinarily conservative and hemodynamic complications are e...BACKGROUND Pubic ramus fractures are generally considered fragility fractures in the elderly population,commonly deriving from a low-impact fall.Treatment is ordinarily conservative and hemodynamic complications are exceedingly infrequent.Notwithstanding,patients with copious comorbidities should be carefully monitored for potential vascular injury.CASE SUMMARY This case report presents the management of a 75-year-old male patient with a history of diabetes mellitus and arterial hypertension who was admitted to the emergency room with a superior pubic ramus fracture.The patient experienced a significant drop in hematocrit and hemoglobin levels post-admission,necessi-tating urgent intervention.A computed tomography angiography revealed active bleeding,leading to the embolization of the medial femoral branch.The patient was stabilized hemodynamically and was discharged after 15 days,with recom-mendations for home-based follow-up care.CONCLUSION This report denotes the various challenges and strategies in managing simple fractures that are treated conservatively,but need prompt monitoring for occult vascular injuries that can be fatal.展开更多
The real-time monitoring of fracture propagation during hydraulic fracturing is crucial for obtaining a deeper understanding of fracture morphology and optimizing hydraulic fracture designs.Accurate measurements of ke...The real-time monitoring of fracture propagation during hydraulic fracturing is crucial for obtaining a deeper understanding of fracture morphology and optimizing hydraulic fracture designs.Accurate measurements of key fracture parameters,such as the fracture height and width,are particularly important to ensure efficient oilfield development and precise fracture diagnosis.This study utilized the optical frequency domain reflectometer(OFDR)technique in physical simulation experiments to monitor fractures during indoor true triaxial hydraulic fracturing experiments.The results indicate that the distributed fiber optic strain monitoring technology can efficiently capture the initiation and expansion of fractures.In horizontal well monitoring,the fiber strain waterfall plot can be used to interpret the fracture width,initiation location,and expansion speed.The fiber response can be divided into three stages:strain contraction convergence,strain band formation,and postshutdown strain rate reversal.When the fracture does not contact the fiber,a dual peak strain phenomenon occurs in the fiber and gradually converges as the fracture approaches.During vertical well monitoring in adjacent wells,within the effective monitoring range of the fiber,the axial strain produced by the fiber can represent the fracture height with an accuracy of 95.6%relative to the actual fracture height.This study provides a new perspective on real-time fracture monitoring.The response patterns of fiber-induced strain due to fractures can help us better understand and assess the dynamic fracture behavior,offering significant value for the optimization of oilfield development and fracture diagnostic techniques.展开更多
BACKGROUND In pediatric age group patients(<18 years old)treated operatively for distal radius/both bone fractures extending imaging beyond the initial postoperative period-particularly in uncomplicated cases-appea...BACKGROUND In pediatric age group patients(<18 years old)treated operatively for distal radius/both bone fractures extending imaging beyond the initial postoperative period-particularly in uncomplicated cases-appears to provide limited additional benefit.AIM To determine the necessary number of follow-up X-rays to use resources efficiently.METHODS Participants included in this study are pediatric age group patients who were treated operatively for distal radius/both bone fractures and were identified from a prospected collected data from the operating room database between the years 2009 and 2017.The data in the study included patients who had distal radius fractures and underwent fixation surgery(n=88).RESULTS When assessing the difference in the odds of conducting 1 or less X-ray compared to 2 or more X-rays in regard to the type of fixation,the only significant difference is the closed reduction fixation method.Patients who underwent closed reduction method procedure have significantly lower odds of having 2 more X-rays compared to those who didn’t have closed reduction method.Open reduction,internal fixation,and other fixation methods(close reduction and internal fixation,debridement,or epiphysiodesis)have higher odds of having two or more X-rays compared to patients who did not receive these methods;however,these odds are not statistically significant.CONCLUSION The findings of this study reveal notable absence of a statistically significant association between the frequency of postoperative X-rays and the outcome of children with distal radius fractures.展开更多
Objective:To evaluate the effectiveness of surgical combination with traditional Chinese medicine dialectical therapy in three phases for the treatment of intertrochanteric fracture of the femur(IFF).Methods:84 patien...Objective:To evaluate the effectiveness of surgical combination with traditional Chinese medicine dialectical therapy in three phases for the treatment of intertrochanteric fracture of the femur(IFF).Methods:84 patients with IFF admitted to the hospital from December 2022 to December 2024 were selected and randomly divided into two groups using a random number table.The combined group received surgery and traditional Chinese medicine dialectical therapy in three phases,while the control group received surgery alone.The total effective rate,fracture healing time,hip function score,and lower extremity function score were compared between the two groups.Results:The total effective rate was higher in the combined group than in the control group(P<0.05).After treatment,the fracture healing time was shorter in the combined group than in the control group,and the hip function and lower extremity function scores were higher in the combined group than in the control group(P<0.05).Conclusion:Surgical combination with traditional Chinese medicine dialectical therapy in three phases can shorten the fracture healing time of IFF patients and restore their hip and lower extremity function,demonstrating significant efficacy.展开更多
文摘Complex trimalleolar ankle fractures are a major orthopaedic challenge,with an incidence of 4.22 per 10000 person-years in the United States and an annual cost of 3.4 billion dollars.This review synthesizes current evidence on diagnostic protocols and management strategies,highlighting optimal approaches and emerging trends.Initial care emphasizes soft tissue assessment,often guided by the Tscherne classification,and fracture classification systems.External fixation may be required in open injuries,while early open reduction and internal fixation within six days is linked to improved outcomes.Minimally invasive techniques for the lateral malleolus,including intramedullary nailing and locking plates,are effective,while medial malleolus fractures are commonly managed with screw fixation or tension-band wiring.Posterior malleolus fragments involving more than 25%of the articular surface usually warrant fixation.Alternatives to syndesmotic screws,such as cortical buttons or high-strength sutures,reduce the need for secondary procedures.Arthroscopic-assisted open reduction and internal fixation benefits younger,active patients by enabling concurrent management of intra-articular and ligamentous injuries.Postoperative care prioritizes early weight-bearing and validated functional scores.Despite advances,complications remain common,and further research is needed to refine surgical strategies and improve outcomes.
文摘BACKGROUND Ankle fractures are well-documented in snow sports,but concomitant Achilles tendon and peroneal tendon ruptures are rare.This case report presents a previously unreported combination of Achilles tendon rupture,peroneal tendon rupture,and fibular fracture in a snowboarder,highlighting the complex nature of diagnosis,management,and rehabilitation.CASE SUMMARY A 50-year-old male snowboarder presented with severe right ankle pain following a high speed tumbling crash.Initial evaluation revealed an Achilles tendon rupture and a non-displaced distal lateral malleolus fracture.Subsequent magnetic resonance imaging confirmed complete tears of the Achilles tendon and both peroneus longus and brevis tendons,along with a Weber A lateral malleolus fracture.Surgical intervention included a 4-suture core Kraków repair of the Achilles tendon with calcaneal docking,open reduction and internal fixation of the distal fibula fracture,and primary repair of both peroneal tendons.Postoperatively,a modified Achilles repair protocol was implemented.At 16 weeks post-surgery,radiographs showed a well-healed fibular fracture,and physical examination confirmed intact Achilles and peroneal tendon repairs.By 6 months,the patient had regained full daily and work activities,including recreational pursuits.CONCLUSION This case underscores the importance of maintaining a high index of suspicion for concomitant injuries in high-energy ankle trauma during snow sports.Timely advanced imaging and a comprehensive surgical approach are crucial for optimal outcomes in such complex cases.
文摘This paper prepared a novel as-cast W-Zr-Ti metallic ESM using high-frequency vacuum induction melting technique.The above ESM performs a typical elastic-brittle material feature and strain rate strengthening behavior.The specimens exhibit violent chemical reaction during the fracture process under the impact loading,and the size distribution of their residual debris follows Rosin-Rammler model.The dynamic fracture toughness is obtained by the fitting of debris length scale,approximately 1.87 MPa·m~(1/2).Microstructure observation on residual debris indicates that the failure process is determined by primary crack propagation under quasi-static compression,while it is affected by multiple cracks propagation in both particle and matrix in the case of dynamic impact.Impact test demonstrates that the novel energetic fragment performs brilliant penetration and combustion effect behind the front target,leading to the effective ignition of fuel tank.For the brittleness of as-cast W-ZrTi ESM,further study conducted bond-based peridynamic(BB-PD)C++computational code to simulate its fracture behavior during penetration.The BB-PD method successfully captured the fracture process and debris cloud formation of the energetic fragment.This paper explores a novel as-cast metallic ESM,and provides an available numerical avenue to the simulation of brittle energetic fragment.
文摘The Gabes aquifer system,located in southeastern Tunisia,is a crucial resource for supporting local socio-economic activities.Due to its dual porosity structure,is particularly vulnerable to pollution.This study aims to develop a hybrid model that combines the Fracture Aquifer Index(FAI)with the conventional GOD(Groundwater occurrence,Overall lithology,Depth to water table)method,to assess groundwater vulnerability in fractured aquifer.To develop the hybrid model,the classical GOD method was integrated with FAI to produce a single composite index.Each parameter within both GOD and FAI was scored,and a final index was calculated to delineate vulnerable areas.The results show that the study area can be classified into four vulnerability levels:Very low,low,moderate,and high,indicating that approximately 8%of the area exhibits very low vulnerability,29%has low vulnerability,25%falls into the moderate category,and 38%is considered highly vulnerable.The FAI-GOD model further incorporates fracture network characteristics.This refinement reduces the classification to three vulnerability classes:Low,medium,and high.The outcomes demonstrate that 46%of the area is highly vulnerable due to a dense concentration of fractures,while 17%represents an intermediate zone characterized by either shallow or deeper fractures.In contrast,37%corresponds to areas with lightly fractured rock,where the impact on vulnerability is minimal.Multivariate statistical analysis was employed using Principal Components Analysis(PCA)and Hierarchical Cluster Analysis(HCA)on 24 samples across six variables.The first three components account for over 76%of the total variance,reinforcing the significance of fracture dynamics in classifying vulnerability levels.The FAI-GOD model removes the very-low-vulnerability class and expands the spatial extent of low-and high-vulnerability zones,reflecting the dominant influence of fracture networks on aquifer sensitivity.While both indices use a five-class system,FAI-GOD redistributes vulnerability by eliminating very-low-vulnerability areas and amplifying low/high categories,highlighting the critical role of fractures.A strong correlation(R2=0.94)between the GOD and FAI-GOD indices,demonstrated through second-order polynomial regression,confirms the robustness of the FAI-GOD model in accurately predicting vulnerability to pollution.This model provides a useful framework for assessing the vulnerability of complex aquifers and serves as a decision-making tool for groundwater managers in similar areas.
基金approved by King Abdullah International Medical Research Center Ethics Committee(approval No.0000074524).
文摘BACKGROUND Humeral shaft fractures are common and vary by age,with high-energy trauma observed in younger adults and low-impact injuries in older adults.Radial nerve palsy is a frequent complication.Treatment ranges from nonoperative methods to surgical interventions such as intramedullary K-wires,which promote faster rehabilitation and improved elbow mobility.AIM To evaluate the outcomes of managing humeral shaft fractures using closed reduction and internal fixation with flexible intramedullary K-wires.METHODS This was a retrospective cohort study analyzing the medical records of patients with humeral shaft fractures managed with flexible intramedullary K-wires at King Abdulaziz Medical City,using non-random sampling and descriptive analysis for outcome evaluation.RESULTS This study assessed the clinical outcomes of 20 patients treated for humeral shaft fractures with intramedullary K-wires.Patients were predominantly male(n=16,80%),had an average age of 39.2 years,and a mean body mass index of 29.5 kg/m^(2).The fractures most frequently occurred in the middle third of the humerus(n=14,70%),with oblique fractures being the most common type(n=7,35%).All surgeries used general anesthesia and a posterior approach,with no intraoperative complications reported.Postoperatively,all patients achieved clinical and radiological union(n=20,100%),and the majority(n=13,65%)reached an elbow range of motion from 0 to 150 degrees.CONCLUSION These results suggest that intramedullary K-wire fixation may be an effective option for treating humeral shaft fractures,with favorable outcomes in range of motion recovery,fracture union,and a low rate of intraoperative complications.
基金Projects(19300604,19300751)supported by the ORSP at Abu Dhabi University,UAE。
文摘This study investigates the fracture behavior of clay-rich mudstone under varying temperature and pressure conditions,which is crucial for the safety of geological structures.It focuses on three fracture types:pure mode I tensile fractures,pure mode II tensile fractures,and shear fractures,examining specimens at room temperature(RT)and after thermal treatments at 250 and 500℃.The findings reveal that increasing temperatures makes the mudstone more brittle,enhancing fracture velocity,toughness,load-bearing capacity,roughness,and the fracture process zone(FPZ)radius.Notably,tensile fractures induced under pure mode II displayed the highest velocities,while shear fractures exhibited the lowest velocities,smoothest surfaces,and greatest resistance to failure.The application of a confining pressure of 4 MPa significantly improved shear fracture toughness by 119.7%,98.5%and 71.9%at RT,250℃and 500℃,respectively,and reduced roughness by 8.2%,22.4%and 30.4%.This research offers a novel,comprehensive view of how temperature and pressure impact fractures in mudstone sensitive to temperature due to its high clay content and water affinity.The findings provide valuable insights applicable to geothermal energy,oil and gas exploration,and underground construction,thereby enhancing the understanding of fracture mechanics in geological contexts.
基金financially supported by,the Fundamental Research Funds for the Central Universities(Grant No.2023QN1064)the China Postdoctoral Science Foundation(Grant No.2023M733772)Jiangsu Funding Program for Excellent Postdoctoral Talent(Grant No.2023ZB847)。
文摘Prepulse combined hydraulic fracturing facilitates the development of fracture networks by integrating prepulse hydraulic loading with conventional hydraulic fracturing.The formation mechanisms of fracture networks between hydraulic and pre-existing fractures under different prepulse loading parameters remain unclear.This research investigates the impact of prepulse loading parameters,including the prepulse loading number ratio(C),prepulse loading stress ratio(S),and prepulse loading frequency(f),on the formation of fracture networks between hydraulic and pre-existing fractures,using both experimental and numerical methods.The results suggest that low prepulse loading stress ratios and high prepulse loading number ratios are advantageous loading modes.Multiple hydraulic fractures are generated in the specimen under the advantageous loading modes,facilitating the development of a complex fracture network.Fatigue damage occurs in the specimen at the prepulse loading stage.The high water pressure at the secondary conventional hydraulic fracturing promotes the growth of hydraulic fractures along the damage zones.This allows the hydraulic fractures to propagate deeply and interact with pre-existing fractures.Under advantageous loading conditions,multiple hydraulic fractures can extend to pre-existing fractures,and these hydraulic fractures penetrate or propagate along pre-existing fractures.Especially when the approach angle is large,the damage range in the specimen during the prepulse loading stage increases,resulting in the formation of more hydraulic fractures.
基金supported by General Projects of the Natural Science Foundation of China(41972313)major projects of the Natural Science Foundation of China(41790453)。
文摘Fractures are critical control factors in volcanic reservoirs.Thus,studies on the prediction and distribution patterns of volcanic fractures are crucial for oil and gas exploration and development.Although considerable research has been conducted on volcanic fractures,targeted research on the spatial distribution patterns of fracture development remains limited in the literature.Two eruption modes,subaqueous eruption and subaerial eruption,have been identified in the Chaganhua subsag of the Songliao Basin,where gas resources have been discovered.Studying the differences in volcanic fracture development is highly important for understanding the law of oil and gas enrichment in volcanic reservoirs.On the basis of thin sections,cores,electrical imaging logs,and other data obtained from boreholes of subaqueous volcanic eruptions in the Songnan fault depression,we describe the characteristics of drilled fractures in detail and use 3D seismic data to extract intrinsic coherence,ant bodies,and Fourier series to extend the azimuthal anisotropic P-wave reflection coefficient,thereby predicting the spatial distribution of fractures at different scales.Moreover,through statistical analysis of quantitative evaluation indicators,such as fracture density and fracture development rate in different drilling wells,combined with the spatial distribution patterns of the predicted fractures,we compared and analyzed the relationships between the distributions of fractures and volcanic institutions,lithology,and volcanic facies.Results indicate that fractures are more developed in volcanic edifices located closer to faults.Considerable differences in fracture development are observed among lithofacies of volcanic rocks.Near faults,effusion facies,explosive facies and external clastic pyroclastic sedimentary subfacies are favorable for fracture development.This research provides a reference for investigating volcanic rock fractures of the same origins worldwide.
基金supported by the National Key Research and Development Program of China(Grant No.2023YFB2390300)the National Natural Science Foundation of China(Grant No.42172292)Yinlin Ji is grateful for the support by the Helmholtz Association's Initiative and Networking Fund for the Helmholtz Young Investigator Group ARES(Contract No.VH-NG-1516).
文摘This study aims to understand the effect of injection rate on injection-induced fracture activation in granite.We performed water injection-induced slip tests on samples containing either a smooth or a rough fracture at four different injection rates under undrained conditions and monitored the acoustic emission(AE)signals during the tests.Experimental results reveal that the critical activation fluid pressure is related to the injection rate,pressure diffusion rate,stress state,and fracture roughness.For the smooth fracture,as the injection rate increases,the critical activation fluid pressure increases significantly,while the injection rate has little effect on the critical activation fluid pressure of the rough fracture.The quasi-static slip distance of fractures decreases as the injection rate increases,with rough fractures exhibiting a greater overall slip distance compared to smooth fractures.The number of AE events per unit sliding distance increases with the injection rate,while the global b value decreases.These results indicate that higher injection rates produce more large-magnitude AE events and more severe slip instability and asperity damage.We established a linkage between fluid injection volume,injection rate,and AE events using the seismogenic index(Σ).The smooth fracture exhibits a steadily increasingΣwith the elapse of injection time,and the rate of increase is higher at higher injection rates;while the rough fracture is featured by a fluctuatingΣ,signifying the intermittent occurrence of large-magnitude AE events associated with the damage of larger fracture asperities.Our results highlight the importance of fracture surface heterogeneity on injection-induced fracture activation and slip.
基金Supported by the National Natural Science Foundation of China(52274051)CNPC-China University of Petroleum(Beijing)Strategic Cooperative Project(ZLZX2020-01).
文摘In order to identify the development characteristics of fracture network in tight conglomerate reservoir of Mahu after hydraulic fracturing,a hydraulic fracturing test site was set up in the second and third members of Triassic Baikouquan Formation(T1b2 and T1b3)in Ma-131 well area,which learned from the successful experience of hydraulic fracturing test sites in North America(HFTS-1).Twelve horizontal wells and a high-angle coring well MaJ02 were drilled.The orientation,connection,propagation law and major controlling factors of hydraulic fractures were analyzed by comparing results of CT scans,imaging logs,direct observation of cores from Well MaJ02,and combined with tracer monitoring data.Results indicate that:(1)Two types of fractures have developed by hydraulic fracturing,i.e.tensile fractures and shear fractures.Tensile fractures are approximately parallel to the direction of the maximum horizontal principal stress,and propagate less than 50 m from perforation clusters.Shear fractures are distributed among tensile fractures and mainly in the strike-slip mode due to the induced stress field among tensile fractures,and some of them are in conjugated pairs.Overall,tensile fractures alternate with shear fractures,with shear fractures dominated and activated after tensile ones.(2)Tracer monitoring results indicate that communication between wells was prevalent in the early stage of production,and the static pressure in the fracture gradually decreased and the connectivity between wells reduced as production progressed.(3)Density of hydraulic fractures is mainly affected by the lithology and fracturing parameters,which is smaller in the mudstone than the conglomerate.Larger fracturing scale and smaller cluster spacing lead to a higher fracture density,which are important directions to improve the well productivity.
基金funded by the National Natural Science Foundation of China(Grant Nos.12172230,U22A20166)the Department of Science and Technology of Guangdong Province(Grant No.2019ZT08G315).
文摘Understanding the anisotropic fracture behavior and the characteristics of the fracture process zone(FPZ)under size effects in laminated rocks,as well as its role in rock fracturing,is crucial for various engineering applications.In this study,three-point bending tests were conducted on shale specimens with varying bedding angles and sizes.The anisotropic characteristics and size effects of fracture parameters were revealed.A comparative analysis was performed on the evolutions of FPZs computed using size effect theory,digital image correlation(DIC),and linear elastic fracture mechanics.The results divulged that:(i)With increasing bedding angles,there is a noticeable decrease in apparent fracture toughness(KICA),apparent fracture energy(GICA),and nominal strength(σ_(Nu)).When the bedding angle of shale is less than 45°,the crack propagation and fracture parameters are mainly influenced by the matrix.Contrary,shale with bedding angles greater than 60°,the crack propagation and fracture parameters are mainly controlled by the bedding.When the bedding angle is between 45°and 60°,the fracture propagation evolves from permeating the matrix to extending along the bedding;(ii)The fracture parameters exhibit significant size dependent behavior,as KICA and GICA rise with increasing specimen size,butσNu falls with increasing specimen sizes.The fracture parameters align with the theoretical predictions of Bažant size effect law;and(iii)The lengths of DIC-based FPZ,effective FPZ,and inelastic zone follow W-shape variations with bedding angle.The dimensionless sizes of FPZ and inelastic zone decrease with specimen size,indicating a size effect.Furthermore,there is a negative relation between KICA and the dimensionless size of the FPZ,whileσNu is positively correlated to the dimensionless size of the FPZ.This highlights the essential role of the FPZ in the size effect of rock fracture.The bedding angle exerts an influence on the FPZ,subsequently affecting the anisotropic fracture and size-dependent behavior of shale.
基金support from the National Natural Science Foundation of China(Grant Nos.42320104003,42177175,and 42077247)the Fundamental Research Funds for the Central Universities.
文摘Accurate prediction of hydraulic fracture propagation is vital for Enhanced Geothermal System(EGS)design.We study the first hydraulic fracturing job at the GR1 well in the Gonghe Basin using field data,where the overall direction of hydraulic fractures does not show a delineated shape parallel to the maximum principal stress orientation.A field-scale numerical model based on the distinct element method is set up to carry out a fully coupled hydromechanical simulation,with the explicit representation of natural fractures via the discrete fracture network(DFN)approach.The effects of injection parameters and in situ stress on hydraulic fracture patterns are then quantitatively assessed.The study reveals that shear-induced deformation primarily governs the fracturing morphology in the GR1 well,driven by smaller injection rates and viscosities that promote massive activation of natural fractures,ultimately dominating the direction of hydraulic fracturing.Furthermore,the increase of in situ differential stress may promote shear damage of natural fracture surfaces,with the exact influence pattern depending on the combination of specific discontinuity properties and in situ stress state.Finally,we provide recommendations for EGS fracturing based on the influence characteristics of multiple parameters.This study can serve as an effective basis and reference for the design and optimization of EGS in the Gonghe basin and other sites.
基金funding from the European Research Council(ERC)under the European Union’s Horizon 2020 Research and Innovation Program through the Starting Grant GEoREST(grant agreement No.801809)support by MICIU/AEI/10.13039/501100011033 and by"European Union Next Generation EU/PRTR"through the‘Ramón y Cajal’fellowship(reference RYC2021-032780-I)+9 种基金funding by MICIU/AEI/10.13039/501100011033 and by“ERDF,EU”through the‘HydroPoreII’project(reference PID2022-137652NBC44)support by the Institute for Korea Spent Nuclear Fuel(iKSNF)National Research Foundation of Korea(NRF)grant funded by the Korea government(Ministry of Science and ICT,MSIT)(2021M2E1A1085196)support by the Swedish Radiation Safety(SSM),Swedish Transport Administration(Trafikverket),Swedish Rock Engineering Foundation(BeFo),and Nordic Energy Research(Grant 187658)supported by the US Department of Energy(DOE),the Officeof Nuclear Energy,Spent Fuel and Waste Science and Technology Campaign,and by the US Department of Energy(DOE),the Office of Basic Energy Sciences,Chemical Sciences,Geosciences,and Biosciences Division both under Contract Number DE-AC02-05CH11231 with Lawrence Berkeley National Laboratorysupport from the US National Science Foundation(grant CMMI-2239630)funding from the European Research Council(ERC)under the European Union’s Horizon 2020 research and innovation programme(grant agreement No.101002507)the UK Natural Environment Research Council(NERC)for funding SeisGreen Project(Grant No.NE/W009293/1)which supported this workthe Royal Society UK for supporting this research through fellowship UF160443IMEDEA is an accredited"Maria de Maeztu Excellence Unit"(Grant CEX2021-001198,funded by MICIU/AEI/10.13039/501100011033).
文摘Coupled thermo-hydro-mechanical(THM)processes in fractured rock are playing a crucial role in geoscience and geoengineering applications.Diverse and conceptually distinct approaches have emerged over the past decades in both continuum and discontinuum perspectives leading to significant progress in their comprehending and modeling.This review paper offers an integrated perspective on existing modeling methodologies providing guidance for model selection based on the initial and boundary conditions.By comparing various models,one can better assess the uncertainties in predictions,particularly those related to the conceptual models.The review explores how these methodologies have significantlyenhanced the fundamental understanding of how fractures respond to fluid injection and production,and improved predictive capabilities pertaining to coupled processes within fractured systems.It emphasizes the importance of utilizing advanced computational technologies and thoroughly considering fundamental theories and principles established through past experimental evidence and practical experience.The selection and calibration of model parameters should be based on typical ranges and applied to the specificconditions of applications.The challenges arising from inherent heterogeneity and uncertainties,nonlinear THM coupled processes,scale dependence,and computational limitations in representing fieldscale fractures are discussed.Realizing potential advances on computational capacity calls for methodical conceptualization,mathematical modeling,selection of numerical solution strategies,implementation,and calibration to foster simulation outcomes that intricately reflectthe nuanced complexities of geological phenomena.Future research efforts should focus on innovative approaches to tackle the hurdles and advance the state-of-the-art in this critical fieldof study.
文摘BACKGROUND Hand in hand with technological advancements,treatment modalities continue to grow.With the turn of the century,the internet has become the number one source of information for almost every topic.Thus,many patients look toward the internet as their primary source of information to learn about their respective medical conditions.The American Medical Association and National Institute of Health strongly recommend that online medical information be written at the 6th to 8th-grade level to aid comprehension by patients of all literacy backgrounds.AIM To assess the readability of online information regarding Jones fracture.Our hypothesis is that the reading level of medical information published on websites far exceeds the recommended reading level of 6th-8th grade as proposed by the American Medical Associate and National Institute of Health.The result of this study can help us formulate improved recommendations for publishing more comprehensible material and,thus,eventually improve patient compliance and clinical outcomes.METHODS The exact phrase“Jones fracture”was queried on the three most common search engines,Google,Yahoo!,and Bing,on December 28,2022.As of December 2022,Google held 84%,Bing held 9%,and Yahoo!held 2%of the worldwide search engine market share.Web pages uniform resource locator from the first three pages of search results were recorded from each search engine.These web pages were classified according to academic,physician-sponsored,governmental and non-government organizations(NGO),commercial,and unspecified as per formally defined categories.Websites associated with an educational institution or medical organization were classified as academic.Websites with products for sale,corporate sponsorship,or advertisements were classified as commercial.Governmental websites or NGOs comprised those that received government subsidies or grants.Webpages that were independently owned by physicians or physician groups were respectively classed as physician sponsored.The remainder of websites that did not fall under the above categories were classified as unspecified.RESULTS A total of 93 websites were analyzed for reading assessment.A whopping 44%of websites were commercial,followed by 22%of physician-sponsored websites.Third place belonged to non-government organization websites holding a 15%share.The academic website held a meager 9%portion,while unspecified sites were 3%.The table illustrates mean readability scores,along with average cumulative grade level.The average grade level was 10.95±2.28 for all websites,with a range of 6.18 to 18.90.Since P values were more than 0.05,there was not a significant statistical difference between the first page results and the results of all pages.Thus,we can rationalize that readability scores are consistent throughout all pages of a website.CONCLUSION Hand in hand with technological advancements,treatment modalities continue to grow.With the turn of the century,the internet has become the number one source of information for almost every topic.Thus,many patients look towards the internet as the primary source of information to learn about their respective medical conditions.Our study demonstrates that current online medical information regarding Jones fracture is written at an extraordinarily high-grade level,with an average grade level of all websites at 10.95,nearly an 10th-grade educational level.The American Medical Association and National Institute of Health strongly recommend that online medical information should be written at the 6th to 8th-grade level to aid comprehension by patients of all literacy backgrounds.On the contrary,most of the medical information evaluated was at an 10th-grade level,which far exceeds recommendations by AMA and NIH.This is particularly relevant because readability scores are directly proportional to the level of comprehension attained by readers,thus directly impacting patient outcomes.In conclusion,we suggest and encourage that all online reading materials should be re-written at the 6th to 8th-grade level in a public service effort to increase compliance with treatment goals and raise awareness of preventive measures.
文摘Pelvic fractures are often caused by high-energy injuries and accompanied by hemodynamic instability.Traditional open surgery has a large amount of bleeding,which is not suitable for patients with acute pelvic fracture.Navigationguided,percutaneous puncture-screw implantation has gradually become a preferred procedure due to its advantages,which include less trauma,faster recovery times,and less bleeding.However,due to the complexity of pelvic anatomy,doctors often encounter some problems when using navigation to treat pelvic fractures.This article reviews the indications,contraindications,surgical procedures,and related complications of this procedure for the treatment of sacral fractures,sacroiliac joint injuries,pelvic ring injuries,and acetabular fractures.We also analyze the causes of inaccurate screw placement.Percutaneous screw placement under navigational guidance has the advantages of high accuracy,low incidence of complications and small soft-tissue damage,minimal blood loss,short hospital stays,and quick recovery.There is no difference in the incidence of complications between surgeries performed by new doctors and experienced ones.However,computer navigation technology requires extensive training,and attention should be given to avoid complications such as screw misplacement,intestinal injury,and serious blood vessel and nerve injuries caused by navigational drift.
文摘BACKGROUND Pubic ramus fractures are generally considered fragility fractures in the elderly population,commonly deriving from a low-impact fall.Treatment is ordinarily conservative and hemodynamic complications are exceedingly infrequent.Notwithstanding,patients with copious comorbidities should be carefully monitored for potential vascular injury.CASE SUMMARY This case report presents the management of a 75-year-old male patient with a history of diabetes mellitus and arterial hypertension who was admitted to the emergency room with a superior pubic ramus fracture.The patient experienced a significant drop in hematocrit and hemoglobin levels post-admission,necessi-tating urgent intervention.A computed tomography angiography revealed active bleeding,leading to the embolization of the medial femoral branch.The patient was stabilized hemodynamically and was discharged after 15 days,with recom-mendations for home-based follow-up care.CONCLUSION This report denotes the various challenges and strategies in managing simple fractures that are treated conservatively,but need prompt monitoring for occult vascular injuries that can be fatal.
基金supported by the National Natural Science Foundation of China(Grant No.52104060)the Natural Science Foundation of Shandong Province,China(Grant No.ZR2021QE015).
文摘The real-time monitoring of fracture propagation during hydraulic fracturing is crucial for obtaining a deeper understanding of fracture morphology and optimizing hydraulic fracture designs.Accurate measurements of key fracture parameters,such as the fracture height and width,are particularly important to ensure efficient oilfield development and precise fracture diagnosis.This study utilized the optical frequency domain reflectometer(OFDR)technique in physical simulation experiments to monitor fractures during indoor true triaxial hydraulic fracturing experiments.The results indicate that the distributed fiber optic strain monitoring technology can efficiently capture the initiation and expansion of fractures.In horizontal well monitoring,the fiber strain waterfall plot can be used to interpret the fracture width,initiation location,and expansion speed.The fiber response can be divided into three stages:strain contraction convergence,strain band formation,and postshutdown strain rate reversal.When the fracture does not contact the fiber,a dual peak strain phenomenon occurs in the fiber and gradually converges as the fracture approaches.During vertical well monitoring in adjacent wells,within the effective monitoring range of the fiber,the axial strain produced by the fiber can represent the fracture height with an accuracy of 95.6%relative to the actual fracture height.This study provides a new perspective on real-time fracture monitoring.The response patterns of fiber-induced strain due to fractures can help us better understand and assess the dynamic fracture behavior,offering significant value for the optimization of oilfield development and fracture diagnostic techniques.
文摘BACKGROUND In pediatric age group patients(<18 years old)treated operatively for distal radius/both bone fractures extending imaging beyond the initial postoperative period-particularly in uncomplicated cases-appears to provide limited additional benefit.AIM To determine the necessary number of follow-up X-rays to use resources efficiently.METHODS Participants included in this study are pediatric age group patients who were treated operatively for distal radius/both bone fractures and were identified from a prospected collected data from the operating room database between the years 2009 and 2017.The data in the study included patients who had distal radius fractures and underwent fixation surgery(n=88).RESULTS When assessing the difference in the odds of conducting 1 or less X-ray compared to 2 or more X-rays in regard to the type of fixation,the only significant difference is the closed reduction fixation method.Patients who underwent closed reduction method procedure have significantly lower odds of having 2 more X-rays compared to those who didn’t have closed reduction method.Open reduction,internal fixation,and other fixation methods(close reduction and internal fixation,debridement,or epiphysiodesis)have higher odds of having two or more X-rays compared to patients who did not receive these methods;however,these odds are not statistically significant.CONCLUSION The findings of this study reveal notable absence of a statistically significant association between the frequency of postoperative X-rays and the outcome of children with distal radius fractures.
文摘Objective:To evaluate the effectiveness of surgical combination with traditional Chinese medicine dialectical therapy in three phases for the treatment of intertrochanteric fracture of the femur(IFF).Methods:84 patients with IFF admitted to the hospital from December 2022 to December 2024 were selected and randomly divided into two groups using a random number table.The combined group received surgery and traditional Chinese medicine dialectical therapy in three phases,while the control group received surgery alone.The total effective rate,fracture healing time,hip function score,and lower extremity function score were compared between the two groups.Results:The total effective rate was higher in the combined group than in the control group(P<0.05).After treatment,the fracture healing time was shorter in the combined group than in the control group,and the hip function and lower extremity function scores were higher in the combined group than in the control group(P<0.05).Conclusion:Surgical combination with traditional Chinese medicine dialectical therapy in three phases can shorten the fracture healing time of IFF patients and restore their hip and lower extremity function,demonstrating significant efficacy.
