Objective: To analyze the therapeutic effect of combining dental arch splint intermaxillary traction with rigid internal fixation for the treatment of facial comminuted fractures. Methods: Sixty patients with facial c...Objective: To analyze the therapeutic effect of combining dental arch splint intermaxillary traction with rigid internal fixation for the treatment of facial comminuted fractures. Methods: Sixty patients with facial comminuted fractures admitted for treatment between July 2023 and December 2024 were selected. Using a random number table method, 30 patients were assigned to the observation group, where moderate traction using a dental arch splint combined with rigid internal fixation was applied. Another 30 patients were assigned to the control group and only received dental arch splint traction treatment. The total effective rate, postoperative recovery indicators, periodontal status, complication rate, and quality of life scores were compared between the two groups. Results: The total effective rate in the observation group was higher than that in the control group. The postoperative recovery indicators and periodontal status in the observation group were superior to those in the control group. The complication rate and quality of life score were lower in the observation group compared to the control group, with P < 0.05. Conclusion: Combining dental arch splint intermaxillary traction with rigid internal fixation can improve the periodontal status and quality of life of patients with facial comminuted fractures, shorten postoperative recovery time, reduce various complications, and enhance surgical efficacy.展开更多
BACKGROUND Comminuted calcaneal fractures present significant treatment challenges.Open reduction and internal fixation carries risks such as infection and skin necrosis,while minimally invasive techniques may comprom...BACKGROUND Comminuted calcaneal fractures present significant treatment challenges.Open reduction and internal fixation carries risks such as infection and skin necrosis,while minimally invasive techniques may compromise reduction stability.Conservative management is generally limited to minimally displaced fractures.Traditional Chinese manual bone-setting has a long history in fracture treatment and is renowned globally for achieving functional reduction.It offers distinct advantages including lower cost,minimal soft tissue trauma,and the avoidance of expensive reduction equipment or internal fixation materials.CASE SUMMARY A 60-year-old female presented with left foot pain and limited mobility following a fall.Computed tomography scan revealed a Sanders type IV calcaneal fracture with a Böhler angle of 0°.A standardized,stepwise Traditional Chinese manual bone-setting was initially performed,followed by percutaneous screw fixation through several mini-incisions after satisfactory alignment was confirmed under fluoroscopy.The Visual Analog Scale score decreased from 5 on postoperative day 1 to 3 by day 3.The American Orthopaedic Foot and Ankle Society score improved from 73 at 6 weeks to 90 at 3 months,indicating rapid functional recovery and high patient satisfaction.At 7 months postoperatively,the American Orthopaedic Foot and Ankle Society score reached 95,prompting removal of internal fixation.At the 6-year follow-up,reduction remained well maintained,with the Böhler angle preserved at 22°.CONCLUSION The combination of Traditional Chinese manual bone-setting and percutaneous screw fixation achieved satisfactory functional reduction for comminuted calcaneal fractures.展开更多
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
Although open leg fractures are very common in orthopedics and traumatology, bilateral open leg fractures are extremely rare and are usually associated with an increased risk of complications. We report a case of a si...Although open leg fractures are very common in orthopedics and traumatology, bilateral open leg fractures are extremely rare and are usually associated with an increased risk of complications. We report a case of a simultaneous, asymmetrical, comminuted and bilateral open fracture of the tibia and fibula by a firearm that occurred during an escape attempt in a 29-year-old prisoner. The pre-operative radiological assessment found an open fracture of both legs of the ballistic type;multiple traumatic gunshot wounds with a narrow entry hole and a wide exit hole. Early surgical intervention of intravenous antibiotics, tetanus prophylaxis and open fracture irrigation and debridement was performed within the 6 hour rule. The treatment consisted of a posterior splint followed by trimming andosteosynthesis using a FESSA external fixator from the military health service. A second operation was not needed. Evolution was favorable with ambulation starting from the 45th day. Simultaneous and bilateral tibia-fibula fractures by a firearm are exceptional, therefore, the treatment was surgical with the pre-operative and post-operative protocols well managed.展开更多
Background: The treatment of distal femoral open comminuted fractures is a major problem for orthopedic surgeon. The basic and important aim in treatment of these fractures is to assemble the condylar fragments and th...Background: The treatment of distal femoral open comminuted fractures is a major problem for orthopedic surgeon. The basic and important aim in treatment of these fractures is to assemble the condylar fragments and then fix the condyles to the femoral shaft by minimum handling of the bone and soft tissues. Objectives: To evaluate the treatment of distal femoral open comminuted fractures (type C2 and C3) with hybrid external fixator. Methods: Thirty-four patients with distal femur open comminuted fracture (type C2 and C3) were treated by hybrid external fixator between January 2005 and December 2008. All of the fractures were opened with extension to joint surface. 30 patients were male and 4 were female. Their average age was 30.5 years (17 to 72 years). Average follow up period was 36 months. 12 patients had isolated fracture and 22 patients had multiple fractures. The bony and functional results were evaluated by the association for the study and application of the method of Ilizarov (ASAMI) protocol and knee society score. Results: 29 out of 34 fractures (85%) had union without bone grafts. Average time of union was 6.1 months (4 - 19 ms). The average knee range of motion was 87.5 degrees (30 - 115 degrees). The bony results were excellent in 24 patients (70.5%), good in 6 (17.7%), fair in 2 (5.9%), and poor in 2 (5.9%), and the functional results were excellent in 10 (29.4%) patients, good in 14 (41.2%), fair in 6 (17.6%), and poor in 4 (11.8%), and the functional results were excellent in 10 (29.4%) patients, good in 14 (41.2%), fair in 6 (17.6%), and poor in 4 (11.8%) according to ASAMI protocol. According to the knee society score the functional results were excellent in 9 (26.44%) patients, good in 13 (38.26%), fair in 7 (20.6%), and poor in 5 (14.7%). Conclusion: Hybrid external fixator is an effective method for treatment of distal femoral open comminuted fractures (type C2 and C3) and may be considered as an alternative surgical methods in the management of these fractures.展开更多
There is a controversy whether the comminuted calcaneal fractures should benefit more from conservative or from surgical treatment. Aiming to contribute to this unsolved clinical question we reviewed the long-term out...There is a controversy whether the comminuted calcaneal fractures should benefit more from conservative or from surgical treatment. Aiming to contribute to this unsolved clinical question we reviewed the long-term outcome (up to 96 months) of in 44 patients (mean age 35 years) with 47 calcaneal fractures who were treated surgically. In these patients open reduction and internal fixation were performed using a calcaneal reconstruction plate. The functional outcome was measured according to the Rowe Score and the level of pain by Visual Analog Scale. The objective outcome was estimated by the current radiographs. The clinical results were good to excellent in 69% of patients. Poor outcome observed in one patient who developed Complex Regional Pain Syndrome in his foot. The radiographic evaluation showed satisfactory reconstruction (according to the Boehler angle measurements) in 35 of operated calcanei. These results indicate on the satisfactory outcome of surgical treatment in the majority of the patients who were diagnosed with comminuted fracture of calcaneus.展开更多
BACKGROUND Comminuted manubrium sterni fractures are rare,and internal fixation methods are limited.This report explored a practical and feasible method of internal fixation for comminuted manubrium sterni fractures.C...BACKGROUND Comminuted manubrium sterni fractures are rare,and internal fixation methods are limited.This report explored a practical and feasible method of internal fixation for comminuted manubrium sterni fractures.CASE SUMMARY A 17-year-old female was injured in a car accident for which she underwent debridement and suturing of her head and anterior chest wounds in another hospital.Eight days later,the patient was transferred to our hospital for surgical treatment.The manubrium sterni was found intraoperatively to be split into three irregular fragments with obvious overlap and separation displacement.Meanwhile,a manubriosternal joint dislocation and left first rib cartilage fracture were observed.The retraction force of the shape-memory alloy staples was used to pull the fracture fragments together.Two more titanium locking plates were then used to fix the manubrium sterni and corpus sterni longitudinally,and the left first rib cartilage fracture was repositioned and fixed with a titanium locking plate.A postoperative computed tomography scan showed reduced and rigid fixation of the comminuted manubrium sterni fractures.The patient recovered well with no significant complaints of discomfort.The patient was discharged 10 days postoperatively after the stitches had been removed.CONCLUSION Shape-memory alloy staples had the advantage of being safe and effective during the repositioning and internal fixation of comminuted manubrium sterni fractures.Therefore,they provided a new surgical option for comminuted manubrium sterni fractures.展开更多
The study assessed the early functional outcomes with cemented titanium implants of radius in the treatment of comminuted fractures of radial heads. The functional outcomes of arthro- plasty with cemented titanium imp...The study assessed the early functional outcomes with cemented titanium implants of radius in the treatment of comminuted fractures of radial heads. The functional outcomes of arthro- plasty with cemented titanium implants of radius in the treatment of radial head fractures （Mason Type Ⅲ： 6; Mason Type Ⅳ： 4） in l0 consecutive patients （mean age, 38 years） were evaluated over a mean time of 23.7 months （18-31 months）. The patients were assessed on the basis of physical examination, functional rating （Mayo） and radiographic findings. The parameters evaluated included motion, stability, pain, and grip strength. Five patients were considered to have excellent results, 4 patients had good results and l patient had fairly good results. There were no cases of infection, prosthetic failure, heterotopic ossification or dislocation. When medial collateral ligament was injured, radial head became the main stabilizing structure of the elbow. Titanium radial head implant may provide the stability similar to that of native radial head. We believe that titanium radial head im- plants may be indicated for the Mason Type Ⅲ and Mason Type IV radial head fractures.展开更多
Objective: In the constantly growing population of people beyond the age of 60 years, the incidence of complex comminuted humeral head fractures increases, thus increasing the need for prosthetic replacement. The purp...Objective: In the constantly growing population of people beyond the age of 60 years, the incidence of complex comminuted humeral head fractures increases, thus increasing the need for prosthetic replacement. The purpose of this study was to determine the long-term results after primary hemiarthroplasty in patients older than 60 years. Methods: From 08/2010 to 12/2015 a prospective study of 54 patients (mean age 75 years) with complex humeral head fracture was performed at the University Hospital Rostock. 24 patients were available for follow-up after 5 - 10 years. Pain, the Karnofsky-index, and the range of motion were obtained as well as radiographs in two planes. The Constant-Murley score and the UCLA rating system were evaluated for functional assessment. Results: 15 patients were painfree. The Karnofsky index deteriorated from 94 preoperatively to 70. The Constant-Murley score of the operated extremity reached 47 points out of possible 100, the uninjured side scored 82 points. The age-specific Constant-Murley score showed more favorable results. The UCLA rating system values leveled up to 22 out of 35 points for the replaced shoulder and 33 points for the other arm. Radiologically, more than 50% of the implants were classified as non-centered and the acromio-humeral space diminished significantly. Conclusions: Primary hemiarthroplasty helps to restore a situation of little or no pain whereas functional and radiological outcome remains limited. Revision surgery or conversion to reverse shoulder arthroplasty was not indicated in any case supporting the clinical value of hemiarthroplasty.展开更多
Self-suspended proppants,which enable clear-water fracturing,represent a promising new class of materials for reservoir stimulation.Given the economic limitations associated with their exclusive use,this study investi...Self-suspended proppants,which enable clear-water fracturing,represent a promising new class of materials for reservoir stimulation.Given the economic limitations associated with their exclusive use,this study investigates proppant transport behavior in hybrid systems combining self-suspended proppants with conventional 40/70 mesh quartz sand at various mixing ratios.A dedicated experimental apparatus was developed to replicate field-relevant complex fracture networks,consisting of a main fracture and two branching fractures with different deflection angles.Using this system,sand bank formation and proppant distribution were examined for both conventional quartz sand fracturing and fracturing augmented with self-suspended proppants.The effects of slurry discharge volume,proppant mixing ratio,sand ratio,and injection location of the self-suspended proppant on transport and placement behavior were systematically analyzed.According to the results,the incorporation of self-suspended proppants markedly enhances the proppant-carrying capacity of the slurry and substantially modifies sand bank morphology.Increasing the discharge volume raises the inlet slope angle and promotes greater proppant penetration into branch fractures.The proportion of self-suspended proppant governs slurry viscoelasticity and,consequently,proppant settling behavior.As the fraction of self-suspended proppant decreases,the equilibrium height of the sand bank increases,while the proppant mass fraction within branch fractures exhibits a non-monotonic response,initially decreasing and then increasing.Variations in sand ratio alter both overall proppant concentration and the self-suspended proppant-to-water ratio,thereby modulating slurry rheology and influencing proppant placement.In addition,changes in injection location affect near-wellbore vortex structures,leading to distinct sand bank morphologies.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
The research presented in this paper aimed to analyze the evolution of fractures in strata in relation to the progress of longwall mining.To achieve this objective,an introscopic probe equipped with a highresolution c...The research presented in this paper aimed to analyze the evolution of fractures in strata in relation to the progress of longwall mining.To achieve this objective,an introscopic probe equipped with a highresolution camera was developed,along with additional equipment that enables continuous recording of the internal surfaces of drainage boreholes exceeding 100 m in depth.The probe was utilized to test two methane drainage boreholes in the Z-3b longwall,which operates within the 501/3 coal seam of the Jankowice mine in Poland.Automatic image analysis methods were applied to evaluate the recorded images,based on a newly developed classificationsystem for fractures categorized by size and number.The results were compared with an analysis of changes in the methane capture rate from the drainage boreholes,which correlated with longwall mining progress.A strong correlation was observed between the number of fractures and the lithology of the strata layers.The largest number of fractures and their evolution were recorded in the coal layers,followed by the shale layers,while the sandstone layers exhibited the least number of fractures.Based on parallel measurements of the methane capture rate from the drainage boreholes during the progress of longwall mining,the extent of the strata's fracture zone was determined to range from 6 m to 36 m.Within the fracture zone,the strata are highly fractured,which leads to an increase in methane emissions through seepage and diffusion processes.展开更多
Hydraulic fracturing serves as a critical technology for reservoir stimulation in deep coalbed methane(CBM)development,where the mechanical properties of gangue layers exert a significant control on fracture propagati...Hydraulic fracturing serves as a critical technology for reservoir stimulation in deep coalbed methane(CBM)development,where the mechanical properties of gangue layers exert a significant control on fracture propagation behavior.To address the unclear mechanisms governing fracture penetration across coal-gangue interfaces,this study employs the Continuum-Discontinuum Element Method(CDEM)to simulate and analyze the vertical propagation of hydraulic fractures initiating within coal seams,based on geomechanical parameters derived from the deep Benxi Formation coal seams in the southeastern Ordos Basin.The investigation systematically examines the influence of geological and operational parameters on cross-interfacial fracture growth.Results demonstrate that vertical stress difference,elastic modulus contrast between coal and gangue layers,interfacial stress differential,and interfacial cohesion at coal-gangue interfaces are critical factors governing hydraulic fracture penetration through these interfaces.High vertical stress differences(>3 MPa)inhibit interfacial dilation,promoting predominant crosslayer fracture propagation.Reduced interfacial stress contrasts and enhanced interfacial cohesion facilitate fracture penetration across interfaces.Furthermore,smaller elastic modulus contrasts between coal and gangue correlate with increased interfacial aperture.Finally,lower injection rates effectively suppress vertical fracture propagation in deep coal reservoirs.This study elucidates the characteristics and mechanisms governing cross-layer fracture propagation in coal–rock composites with interbedded partings,and delineates the dynamic evolution laws and dominant controlling factors involved.Thefindings provide critical theoretical insights for the optimization of fracture design and the efficient development of deep coalbed methane reservoirs.展开更多
Background:Biological osteosynthesis preserves blood supply and promotes rapid healing by aligning fracture fragments without direct surgical exposure.Pedicle screws are primarily designed for internal fixation in spi...Background:Biological osteosynthesis preserves blood supply and promotes rapid healing by aligning fracture fragments without direct surgical exposure.Pedicle screws are primarily designed for internal fixation in spinal procedures.A key objec-tive of many orthopedic studies is to assess the biocompatibility of implants with bone and adjacent soft tissue.This study aims to evaluate the biocompatibility and effects of the Pedicle screw-Rod configuration as a novel external fixation method in canine tibial osteotomy.Methods:With ethics approval,eight healthy,intact male dogs,aged 10-12 months and weighing between 20 and 22 kg,underwent a minimally invasive medial tibial approach for surgical fixation of tibial osteotomy using a Pedicle screw-Rod configu-ration.Postoperative evaluations included ultrasound assessments at the osteotomy site and histological evaluations at the bone-screw interface.Results:B-mode ultrasound evaluation indicated healing progress at all osteotomy sites.The color Doppler examination revealed an initial increase in signals in the sur-rounding soft tissue during the first 4 weeks post-operation,followed by a decrease in signals within the adjacent soft tissue between the 5th and 8th weeks.During this latter period,the signals were primarily concentrated on the bone surface and the callus.The bone-screw interface at various screw sites exhibited similar histological changes,indicating effective integration of the newly formed woven bone into the screw threads.Conclusions:Fixation of non-articular tibial osteotomy with Pedicle screw-Rod con-figuration resulted in secondary bone healing,characterized by abundant callus for-mation and neovascularization.This implant demonstrated favorable biocompatibility with bone and surrounding soft tissue,without significant complications.展开更多
Objective:To analyze the clinical application value of autologous periosteum graft combined with platelet-rich plasma(PRP)in the treatment of long bone fractures in the extremities.Methods:A total of 40 patients with ...Objective:To analyze the clinical application value of autologous periosteum graft combined with platelet-rich plasma(PRP)in the treatment of long bone fractures in the extremities.Methods:A total of 40 patients with long bone fractures in the extremities admitted to Santai Hospital Affiliated to North Sichuan Medical College from January 2023 to January 2025 were included,including cases of upper extremity forearm fractures and lower extremity femoral and tibial fractures.The patients were evenly divided using a random number table,with the control group undergoing open reduction and internal fixation(ORIF)combined with autologous periosteum graft,and the observation group undergoing ORIF,autologous periosteum graft,and PRP injection.Surgical indicators,complication rates,excellent fracture healing rates,functional satisfaction,and joint range of motion were compared between the two groups.Results:The surgical indicators in the observation group were similar to those in the control group(p>0.05).The complication rate in the observation group was lower than that in the control group,while the excellent fracture healing rate and functional satisfaction were higher in the observation group(p<0.05).Conclusion:Autologous periosteum graft combined with PRP technology is safe and reliable for the treatment of long bone fractures in the extremities,with satisfactory clinical outcomes.展开更多
Internal structural defects in engineering rock masses vary in size,exhibit complex shapes,and are unevenly distributed.Dominant fractures within a rock mass often play a critical to its mechanical behavior,directly a...Internal structural defects in engineering rock masses vary in size,exhibit complex shapes,and are unevenly distributed.Dominant fractures within a rock mass often play a critical to its mechanical behavior,directly affecting the macromechanical properties and failure modes.These fractures affect the instability and failure of the surrounding rock,significantlyimpacting the overall stability of engineering structures.Herein,sand-powder three-dimensional(3D)printing technology was used to prepare rock-like specimens with internal fracture networks.Triaxial compression testing,post-failure fracture mapping,and fractal dimension analysis of the fracture surfaces were conducted to investigate the effects of dominant fracture angles on the strength and deformation of rocks with internal fracture networks under triaxial stress.The results indicate that the dominant fracture angle has a pronounced effect on the mechanical behavior of rock.With increasing angle,both compressive strength and elastic modulus exhibit an initial decline followed by an increase.Moreover,higher confiningpressure significantlyimproves the compressive strength of fractured rock.This enhancement weakens as the confiningpressure further increases.Moreover,with increasing confiningpressure,the differences between the maximum and minimum values of elastic moduli and lateral strain ratios in fractured rock gradually decrease.Thus,the impact of the dominant fracture angle on rock mass deformation decreases with increasing confiningpressure.This research elucidates the effects of dominant fracture angles on the mechanical and failure properties of complex fractured rock masses and the influenceof the confiningpressure on these relationships.It provides valuable theoretical insights and practical guidance for stability analyses in engineering rock masses.展开更多
One of the key challenges for underground rock reservoirs is ensuring prevention of the unwanted fluid leakage through rock fracture networks during their service life.Microbial-induced calcium carbonate precipitation...One of the key challenges for underground rock reservoirs is ensuring prevention of the unwanted fluid leakage through rock fracture networks during their service life.Microbial-induced calcium carbonate precipitation(MICP)technology has emerged as a promising bio-healing method for rock fractures with small apertures.In this study,a new“three-stage”injection strategy-based MICP(TS-MICP)bio-healing method was proposed,aiming to achieve a“three-high”performance that includes high bridging rate,high mechanical strength,and high homogeneity.A series of meter-scale rock fracture models were prepared to conduct TS-MICP grouting tests.Compared with the traditional injection strategy-based biohealing methods,the TS-MICP method significantly improved the bridging rate(32.1%e89.5%),mechanical properties(0.138e1.023 MPa),and homogeneity of CaCO_(3)precipitation(334.4%).Additionally,it achieved a higher material utilization rate(1.72 times higher),reducing the consumption of cementation solution(CS)by 258.8%,thereby demonstrating greater potential for field applications.The underlying mechanism for achieving high bridging rate and high homogeneity in CaCO_(3)precipitation can be attributed to the synergistic effects of the coupling injection strategy,which optimizes the advantages at each stage.In stage I,under the influence of gravity,the rapid flocculation and hydrogen bonding interactions of organic matter lead to formation of the dense and high-strength CaCO_(3)precipitation at the bottom using a low-concentration bacterial suspension(BS).This process establishes bridging steps along the wall sides for subsequent uniform CaCO_(3)precipitation.In stage II,concentrated BS is utilized to produce looser CaCO_(3)flocculation,which precipitates uniformly on the pre-existing bridging steps.In stage III,a two-step injection strategy was employed to reinforce the loose CaCO_(3)crystals formed in stages I and II,and finally forms a strong bridging effect with“three-high”performance.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
Radial head(RH)arthroplasty(RHA)has emerged as a critical intervention in the management of complex elbow fractures,particularly Mason type III and IV injuries where the native RH is irreparable.Beyond its role in pai...Radial head(RH)arthroplasty(RHA)has emerged as a critical intervention in the management of complex elbow fractures,particularly Mason type III and IV injuries where the native RH is irreparable.Beyond its role in pain relief and joint congruity,RHA serves as a biomechanical cornerstone for restoring the lateral column and ensuring elbow stability,especially in the presence of associated ligamentous injuries or fracture-dislocations.This editorial synthesizes current evidence on RHA in Mason type III and IV RH fractures,with attention to biomechanical rationale,implant design,and complication trends.Aiming to reaffirm RHA’s position as a vital tool in contemporary elbow trauma care,a simplified treatment algorithm is presented to support individualized surgical decisionmaking.展开更多
Objective The aim of this study was to explore the influence of working length(determined by the screw position)on the stiffness and interfragmentary strain(IFS)of femoral locking compression plate(LCP)external fixato...Objective The aim of this study was to explore the influence of working length(determined by the screw position)on the stiffness and interfragmentary strain(IFS)of femoral locking compression plate(LCP)external fixators for lower tibial fractures under full weight-bearing conditions,with the goal of providing a reference basis for clinical applications.Methods Finite element analysis software was used to construct a model of a lower tibial fracture with external femoral LCP fixation.The models were divided into four groups according to the different working lengths(external femoral locking plate fixation 1[EF1],EF2,EF3,and EF4).Stress distribution clouds,fracture end displacements,stiffness and IFS were tested for each model group at different loads.Results Compared with those in the EF1 group,the stiffnesses in the EF2,EF3,and EF4 groups decreased by 28%,31%,and 37%,respectively,under axial compression loading.Compared with those in the EF1 group,the stiffnesses in the EF2,EF3,and EF4 groups decreased by 19%,33%,and 35%,respectively,under axial torsion loading.Compared with those in the EF1 group,the stiffnesses in the EF2,EF3,and EF4 groups decreased by 32%,33%,and 35%,respectively,under a three-point bending load.The IFS of the four finite element models increased with the working length of the plate,with EF1(76%)<EF2(107%)<EF3(110%)<EF4(122%).Finite element analysis revealed that under full weight-bearing conditions,the structural stiffness of the femoral LCP external fixator decreased with increasing working length,leading to an increase in the IFS,which resulted in an IFS that exceeded the ideal range required for secondary healing.Conclusion For unstable lower tibial fractures,screws in the femoral LCP external fixator should be placed as close to the fracture end as possible to increase stability and promote fracture healing.展开更多
基金Special Support Program for Scientific and Technological Talent“Application and Impact of Dental Arch Splint Intermaxillary Traction Combined with Rigid Internal Fixation on Oral Health in Patients with Facial Fractures”(DX2023BR18)。
文摘Objective: To analyze the therapeutic effect of combining dental arch splint intermaxillary traction with rigid internal fixation for the treatment of facial comminuted fractures. Methods: Sixty patients with facial comminuted fractures admitted for treatment between July 2023 and December 2024 were selected. Using a random number table method, 30 patients were assigned to the observation group, where moderate traction using a dental arch splint combined with rigid internal fixation was applied. Another 30 patients were assigned to the control group and only received dental arch splint traction treatment. The total effective rate, postoperative recovery indicators, periodontal status, complication rate, and quality of life scores were compared between the two groups. Results: The total effective rate in the observation group was higher than that in the control group. The postoperative recovery indicators and periodontal status in the observation group were superior to those in the control group. The complication rate and quality of life score were lower in the observation group compared to the control group, with P < 0.05. Conclusion: Combining dental arch splint intermaxillary traction with rigid internal fixation can improve the periodontal status and quality of life of patients with facial comminuted fractures, shorten postoperative recovery time, reduce various complications, and enhance surgical efficacy.
基金Supported by Jin-Wen Liu Academic Experience Heritage Studio Special Fund of National Famous Traditional Chinese Medicine,No.75.
文摘BACKGROUND Comminuted calcaneal fractures present significant treatment challenges.Open reduction and internal fixation carries risks such as infection and skin necrosis,while minimally invasive techniques may compromise reduction stability.Conservative management is generally limited to minimally displaced fractures.Traditional Chinese manual bone-setting has a long history in fracture treatment and is renowned globally for achieving functional reduction.It offers distinct advantages including lower cost,minimal soft tissue trauma,and the avoidance of expensive reduction equipment or internal fixation materials.CASE SUMMARY A 60-year-old female presented with left foot pain and limited mobility following a fall.Computed tomography scan revealed a Sanders type IV calcaneal fracture with a Böhler angle of 0°.A standardized,stepwise Traditional Chinese manual bone-setting was initially performed,followed by percutaneous screw fixation through several mini-incisions after satisfactory alignment was confirmed under fluoroscopy.The Visual Analog Scale score decreased from 5 on postoperative day 1 to 3 by day 3.The American Orthopaedic Foot and Ankle Society score improved from 73 at 6 weeks to 90 at 3 months,indicating rapid functional recovery and high patient satisfaction.At 7 months postoperatively,the American Orthopaedic Foot and Ankle Society score reached 95,prompting removal of internal fixation.At the 6-year follow-up,reduction remained well maintained,with the Böhler angle preserved at 22°.CONCLUSION The combination of Traditional Chinese manual bone-setting and percutaneous screw fixation achieved satisfactory functional reduction for comminuted calcaneal fractures.
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Although open leg fractures are very common in orthopedics and traumatology, bilateral open leg fractures are extremely rare and are usually associated with an increased risk of complications. We report a case of a simultaneous, asymmetrical, comminuted and bilateral open fracture of the tibia and fibula by a firearm that occurred during an escape attempt in a 29-year-old prisoner. The pre-operative radiological assessment found an open fracture of both legs of the ballistic type;multiple traumatic gunshot wounds with a narrow entry hole and a wide exit hole. Early surgical intervention of intravenous antibiotics, tetanus prophylaxis and open fracture irrigation and debridement was performed within the 6 hour rule. The treatment consisted of a posterior splint followed by trimming andosteosynthesis using a FESSA external fixator from the military health service. A second operation was not needed. Evolution was favorable with ambulation starting from the 45th day. Simultaneous and bilateral tibia-fibula fractures by a firearm are exceptional, therefore, the treatment was surgical with the pre-operative and post-operative protocols well managed.
文摘Background: The treatment of distal femoral open comminuted fractures is a major problem for orthopedic surgeon. The basic and important aim in treatment of these fractures is to assemble the condylar fragments and then fix the condyles to the femoral shaft by minimum handling of the bone and soft tissues. Objectives: To evaluate the treatment of distal femoral open comminuted fractures (type C2 and C3) with hybrid external fixator. Methods: Thirty-four patients with distal femur open comminuted fracture (type C2 and C3) were treated by hybrid external fixator between January 2005 and December 2008. All of the fractures were opened with extension to joint surface. 30 patients were male and 4 were female. Their average age was 30.5 years (17 to 72 years). Average follow up period was 36 months. 12 patients had isolated fracture and 22 patients had multiple fractures. The bony and functional results were evaluated by the association for the study and application of the method of Ilizarov (ASAMI) protocol and knee society score. Results: 29 out of 34 fractures (85%) had union without bone grafts. Average time of union was 6.1 months (4 - 19 ms). The average knee range of motion was 87.5 degrees (30 - 115 degrees). The bony results were excellent in 24 patients (70.5%), good in 6 (17.7%), fair in 2 (5.9%), and poor in 2 (5.9%), and the functional results were excellent in 10 (29.4%) patients, good in 14 (41.2%), fair in 6 (17.6%), and poor in 4 (11.8%), and the functional results were excellent in 10 (29.4%) patients, good in 14 (41.2%), fair in 6 (17.6%), and poor in 4 (11.8%) according to ASAMI protocol. According to the knee society score the functional results were excellent in 9 (26.44%) patients, good in 13 (38.26%), fair in 7 (20.6%), and poor in 5 (14.7%). Conclusion: Hybrid external fixator is an effective method for treatment of distal femoral open comminuted fractures (type C2 and C3) and may be considered as an alternative surgical methods in the management of these fractures.
文摘There is a controversy whether the comminuted calcaneal fractures should benefit more from conservative or from surgical treatment. Aiming to contribute to this unsolved clinical question we reviewed the long-term outcome (up to 96 months) of in 44 patients (mean age 35 years) with 47 calcaneal fractures who were treated surgically. In these patients open reduction and internal fixation were performed using a calcaneal reconstruction plate. The functional outcome was measured according to the Rowe Score and the level of pain by Visual Analog Scale. The objective outcome was estimated by the current radiographs. The clinical results were good to excellent in 69% of patients. Poor outcome observed in one patient who developed Complex Regional Pain Syndrome in his foot. The radiographic evaluation showed satisfactory reconstruction (according to the Boehler angle measurements) in 35 of operated calcanei. These results indicate on the satisfactory outcome of surgical treatment in the majority of the patients who were diagnosed with comminuted fracture of calcaneus.
基金Supported by Shenyang Medical College Youth Scientific Research Fund,No.20202027.
文摘BACKGROUND Comminuted manubrium sterni fractures are rare,and internal fixation methods are limited.This report explored a practical and feasible method of internal fixation for comminuted manubrium sterni fractures.CASE SUMMARY A 17-year-old female was injured in a car accident for which she underwent debridement and suturing of her head and anterior chest wounds in another hospital.Eight days later,the patient was transferred to our hospital for surgical treatment.The manubrium sterni was found intraoperatively to be split into three irregular fragments with obvious overlap and separation displacement.Meanwhile,a manubriosternal joint dislocation and left first rib cartilage fracture were observed.The retraction force of the shape-memory alloy staples was used to pull the fracture fragments together.Two more titanium locking plates were then used to fix the manubrium sterni and corpus sterni longitudinally,and the left first rib cartilage fracture was repositioned and fixed with a titanium locking plate.A postoperative computed tomography scan showed reduced and rigid fixation of the comminuted manubrium sterni fractures.The patient recovered well with no significant complaints of discomfort.The patient was discharged 10 days postoperatively after the stitches had been removed.CONCLUSION Shape-memory alloy staples had the advantage of being safe and effective during the repositioning and internal fixation of comminuted manubrium sterni fractures.Therefore,they provided a new surgical option for comminuted manubrium sterni fractures.
文摘The study assessed the early functional outcomes with cemented titanium implants of radius in the treatment of comminuted fractures of radial heads. The functional outcomes of arthro- plasty with cemented titanium implants of radius in the treatment of radial head fractures （Mason Type Ⅲ： 6; Mason Type Ⅳ： 4） in l0 consecutive patients （mean age, 38 years） were evaluated over a mean time of 23.7 months （18-31 months）. The patients were assessed on the basis of physical examination, functional rating （Mayo） and radiographic findings. The parameters evaluated included motion, stability, pain, and grip strength. Five patients were considered to have excellent results, 4 patients had good results and l patient had fairly good results. There were no cases of infection, prosthetic failure, heterotopic ossification or dislocation. When medial collateral ligament was injured, radial head became the main stabilizing structure of the elbow. Titanium radial head implant may provide the stability similar to that of native radial head. We believe that titanium radial head im- plants may be indicated for the Mason Type Ⅲ and Mason Type IV radial head fractures.
文摘Objective: In the constantly growing population of people beyond the age of 60 years, the incidence of complex comminuted humeral head fractures increases, thus increasing the need for prosthetic replacement. The purpose of this study was to determine the long-term results after primary hemiarthroplasty in patients older than 60 years. Methods: From 08/2010 to 12/2015 a prospective study of 54 patients (mean age 75 years) with complex humeral head fracture was performed at the University Hospital Rostock. 24 patients were available for follow-up after 5 - 10 years. Pain, the Karnofsky-index, and the range of motion were obtained as well as radiographs in two planes. The Constant-Murley score and the UCLA rating system were evaluated for functional assessment. Results: 15 patients were painfree. The Karnofsky index deteriorated from 94 preoperatively to 70. The Constant-Murley score of the operated extremity reached 47 points out of possible 100, the uninjured side scored 82 points. The age-specific Constant-Murley score showed more favorable results. The UCLA rating system values leveled up to 22 out of 35 points for the replaced shoulder and 33 points for the other arm. Radiologically, more than 50% of the implants were classified as non-centered and the acromio-humeral space diminished significantly. Conclusions: Primary hemiarthroplasty helps to restore a situation of little or no pain whereas functional and radiological outcome remains limited. Revision surgery or conversion to reverse shoulder arthroplasty was not indicated in any case supporting the clinical value of hemiarthroplasty.
基金the China National Petroleum Corporation’s Forward-Looking Fundamental Technology Breakthrough Project(2021DJ2305).
文摘Self-suspended proppants,which enable clear-water fracturing,represent a promising new class of materials for reservoir stimulation.Given the economic limitations associated with their exclusive use,this study investigates proppant transport behavior in hybrid systems combining self-suspended proppants with conventional 40/70 mesh quartz sand at various mixing ratios.A dedicated experimental apparatus was developed to replicate field-relevant complex fracture networks,consisting of a main fracture and two branching fractures with different deflection angles.Using this system,sand bank formation and proppant distribution were examined for both conventional quartz sand fracturing and fracturing augmented with self-suspended proppants.The effects of slurry discharge volume,proppant mixing ratio,sand ratio,and injection location of the self-suspended proppant on transport and placement behavior were systematically analyzed.According to the results,the incorporation of self-suspended proppants markedly enhances the proppant-carrying capacity of the slurry and substantially modifies sand bank morphology.Increasing the discharge volume raises the inlet slope angle and promotes greater proppant penetration into branch fractures.The proportion of self-suspended proppant governs slurry viscoelasticity and,consequently,proppant settling behavior.As the fraction of self-suspended proppant decreases,the equilibrium height of the sand bank increases,while the proppant mass fraction within branch fractures exhibits a non-monotonic response,initially decreasing and then increasing.Variations in sand ratio alter both overall proppant concentration and the self-suspended proppant-to-water ratio,thereby modulating slurry rheology and influencing proppant placement.In addition,changes in injection location affect near-wellbore vortex structures,leading to distinct sand bank morphologies.
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the PICTO project(RFCR-CT-2018-800711)funded by the European Research Fund for Coal and Steel(RFCS)and the Polish Ministry of Science and Higher Education(W93/FBWiS/2018).
文摘The research presented in this paper aimed to analyze the evolution of fractures in strata in relation to the progress of longwall mining.To achieve this objective,an introscopic probe equipped with a highresolution camera was developed,along with additional equipment that enables continuous recording of the internal surfaces of drainage boreholes exceeding 100 m in depth.The probe was utilized to test two methane drainage boreholes in the Z-3b longwall,which operates within the 501/3 coal seam of the Jankowice mine in Poland.Automatic image analysis methods were applied to evaluate the recorded images,based on a newly developed classificationsystem for fractures categorized by size and number.The results were compared with an analysis of changes in the methane capture rate from the drainage boreholes,which correlated with longwall mining progress.A strong correlation was observed between the number of fractures and the lithology of the strata layers.The largest number of fractures and their evolution were recorded in the coal layers,followed by the shale layers,while the sandstone layers exhibited the least number of fractures.Based on parallel measurements of the methane capture rate from the drainage boreholes during the progress of longwall mining,the extent of the strata's fracture zone was determined to range from 6 m to 36 m.Within the fracture zone,the strata are highly fractured,which leads to an increase in methane emissions through seepage and diffusion processes.
文摘Hydraulic fracturing serves as a critical technology for reservoir stimulation in deep coalbed methane(CBM)development,where the mechanical properties of gangue layers exert a significant control on fracture propagation behavior.To address the unclear mechanisms governing fracture penetration across coal-gangue interfaces,this study employs the Continuum-Discontinuum Element Method(CDEM)to simulate and analyze the vertical propagation of hydraulic fractures initiating within coal seams,based on geomechanical parameters derived from the deep Benxi Formation coal seams in the southeastern Ordos Basin.The investigation systematically examines the influence of geological and operational parameters on cross-interfacial fracture growth.Results demonstrate that vertical stress difference,elastic modulus contrast between coal and gangue layers,interfacial stress differential,and interfacial cohesion at coal-gangue interfaces are critical factors governing hydraulic fracture penetration through these interfaces.High vertical stress differences(>3 MPa)inhibit interfacial dilation,promoting predominant crosslayer fracture propagation.Reduced interfacial stress contrasts and enhanced interfacial cohesion facilitate fracture penetration across interfaces.Furthermore,smaller elastic modulus contrasts between coal and gangue correlate with increased interfacial aperture.Finally,lower injection rates effectively suppress vertical fracture propagation in deep coal reservoirs.This study elucidates the characteristics and mechanisms governing cross-layer fracture propagation in coal–rock composites with interbedded partings,and delineates the dynamic evolution laws and dominant controlling factors involved.Thefindings provide critical theoretical insights for the optimization of fracture design and the efficient development of deep coalbed methane reservoirs.
基金The Vice Chancellor of Research and Technology at Urmia University。
文摘Background:Biological osteosynthesis preserves blood supply and promotes rapid healing by aligning fracture fragments without direct surgical exposure.Pedicle screws are primarily designed for internal fixation in spinal procedures.A key objec-tive of many orthopedic studies is to assess the biocompatibility of implants with bone and adjacent soft tissue.This study aims to evaluate the biocompatibility and effects of the Pedicle screw-Rod configuration as a novel external fixation method in canine tibial osteotomy.Methods:With ethics approval,eight healthy,intact male dogs,aged 10-12 months and weighing between 20 and 22 kg,underwent a minimally invasive medial tibial approach for surgical fixation of tibial osteotomy using a Pedicle screw-Rod configu-ration.Postoperative evaluations included ultrasound assessments at the osteotomy site and histological evaluations at the bone-screw interface.Results:B-mode ultrasound evaluation indicated healing progress at all osteotomy sites.The color Doppler examination revealed an initial increase in signals in the sur-rounding soft tissue during the first 4 weeks post-operation,followed by a decrease in signals within the adjacent soft tissue between the 5th and 8th weeks.During this latter period,the signals were primarily concentrated on the bone surface and the callus.The bone-screw interface at various screw sites exhibited similar histological changes,indicating effective integration of the newly formed woven bone into the screw threads.Conclusions:Fixation of non-articular tibial osteotomy with Pedicle screw-Rod con-figuration resulted in secondary bone healing,characterized by abundant callus for-mation and neovascularization.This implant demonstrated favorable biocompatibility with bone and surrounding soft tissue,without significant complications.
文摘Objective:To analyze the clinical application value of autologous periosteum graft combined with platelet-rich plasma(PRP)in the treatment of long bone fractures in the extremities.Methods:A total of 40 patients with long bone fractures in the extremities admitted to Santai Hospital Affiliated to North Sichuan Medical College from January 2023 to January 2025 were included,including cases of upper extremity forearm fractures and lower extremity femoral and tibial fractures.The patients were evenly divided using a random number table,with the control group undergoing open reduction and internal fixation(ORIF)combined with autologous periosteum graft,and the observation group undergoing ORIF,autologous periosteum graft,and PRP injection.Surgical indicators,complication rates,excellent fracture healing rates,functional satisfaction,and joint range of motion were compared between the two groups.Results:The surgical indicators in the observation group were similar to those in the control group(p>0.05).The complication rate in the observation group was lower than that in the control group,while the excellent fracture healing rate and functional satisfaction were higher in the observation group(p<0.05).Conclusion:Autologous periosteum graft combined with PRP technology is safe and reliable for the treatment of long bone fractures in the extremities,with satisfactory clinical outcomes.
基金supported by the National Key Research and Development Program Young Scientist Project(Grant No.2024YFC2911000)the National Natural Science Foundation of China(Grant No.52474103)the Major Basic Research Project of the Natural Science Foundation of Shandong Province(Grant No.ZR2024ZD22).
文摘Internal structural defects in engineering rock masses vary in size,exhibit complex shapes,and are unevenly distributed.Dominant fractures within a rock mass often play a critical to its mechanical behavior,directly affecting the macromechanical properties and failure modes.These fractures affect the instability and failure of the surrounding rock,significantlyimpacting the overall stability of engineering structures.Herein,sand-powder three-dimensional(3D)printing technology was used to prepare rock-like specimens with internal fracture networks.Triaxial compression testing,post-failure fracture mapping,and fractal dimension analysis of the fracture surfaces were conducted to investigate the effects of dominant fracture angles on the strength and deformation of rocks with internal fracture networks under triaxial stress.The results indicate that the dominant fracture angle has a pronounced effect on the mechanical behavior of rock.With increasing angle,both compressive strength and elastic modulus exhibit an initial decline followed by an increase.Moreover,higher confiningpressure significantlyimproves the compressive strength of fractured rock.This enhancement weakens as the confiningpressure further increases.Moreover,with increasing confiningpressure,the differences between the maximum and minimum values of elastic moduli and lateral strain ratios in fractured rock gradually decrease.Thus,the impact of the dominant fracture angle on rock mass deformation decreases with increasing confiningpressure.This research elucidates the effects of dominant fracture angles on the mechanical and failure properties of complex fractured rock masses and the influenceof the confiningpressure on these relationships.It provides valuable theoretical insights and practical guidance for stability analyses in engineering rock masses.
基金supported by the National Key Research and Development Program of China(Grant No.2023YFC3007102)the National Natural Science Foundation of China(Grant Nos.42477188 and 41925012).
文摘One of the key challenges for underground rock reservoirs is ensuring prevention of the unwanted fluid leakage through rock fracture networks during their service life.Microbial-induced calcium carbonate precipitation(MICP)technology has emerged as a promising bio-healing method for rock fractures with small apertures.In this study,a new“three-stage”injection strategy-based MICP(TS-MICP)bio-healing method was proposed,aiming to achieve a“three-high”performance that includes high bridging rate,high mechanical strength,and high homogeneity.A series of meter-scale rock fracture models were prepared to conduct TS-MICP grouting tests.Compared with the traditional injection strategy-based biohealing methods,the TS-MICP method significantly improved the bridging rate(32.1%e89.5%),mechanical properties(0.138e1.023 MPa),and homogeneity of CaCO_(3)precipitation(334.4%).Additionally,it achieved a higher material utilization rate(1.72 times higher),reducing the consumption of cementation solution(CS)by 258.8%,thereby demonstrating greater potential for field applications.The underlying mechanism for achieving high bridging rate and high homogeneity in CaCO_(3)precipitation can be attributed to the synergistic effects of the coupling injection strategy,which optimizes the advantages at each stage.In stage I,under the influence of gravity,the rapid flocculation and hydrogen bonding interactions of organic matter lead to formation of the dense and high-strength CaCO_(3)precipitation at the bottom using a low-concentration bacterial suspension(BS).This process establishes bridging steps along the wall sides for subsequent uniform CaCO_(3)precipitation.In stage II,concentrated BS is utilized to produce looser CaCO_(3)flocculation,which precipitates uniformly on the pre-existing bridging steps.In stage III,a two-step injection strategy was employed to reinforce the loose CaCO_(3)crystals formed in stages I and II,and finally forms a strong bridging effect with“three-high”performance.
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Radial head(RH)arthroplasty(RHA)has emerged as a critical intervention in the management of complex elbow fractures,particularly Mason type III and IV injuries where the native RH is irreparable.Beyond its role in pain relief and joint congruity,RHA serves as a biomechanical cornerstone for restoring the lateral column and ensuring elbow stability,especially in the presence of associated ligamentous injuries or fracture-dislocations.This editorial synthesizes current evidence on RHA in Mason type III and IV RH fractures,with attention to biomechanical rationale,implant design,and complication trends.Aiming to reaffirm RHA’s position as a vital tool in contemporary elbow trauma care,a simplified treatment algorithm is presented to support individualized surgical decisionmaking.
基金supported by the Health Commission of Guizhou Province(No.gzwkj2024-400)the“Open Competition Project”of Bijie Science and Technology Bureau(BST Major Project No.1,2022).
文摘Objective The aim of this study was to explore the influence of working length(determined by the screw position)on the stiffness and interfragmentary strain(IFS)of femoral locking compression plate(LCP)external fixators for lower tibial fractures under full weight-bearing conditions,with the goal of providing a reference basis for clinical applications.Methods Finite element analysis software was used to construct a model of a lower tibial fracture with external femoral LCP fixation.The models were divided into four groups according to the different working lengths(external femoral locking plate fixation 1[EF1],EF2,EF3,and EF4).Stress distribution clouds,fracture end displacements,stiffness and IFS were tested for each model group at different loads.Results Compared with those in the EF1 group,the stiffnesses in the EF2,EF3,and EF4 groups decreased by 28%,31%,and 37%,respectively,under axial compression loading.Compared with those in the EF1 group,the stiffnesses in the EF2,EF3,and EF4 groups decreased by 19%,33%,and 35%,respectively,under axial torsion loading.Compared with those in the EF1 group,the stiffnesses in the EF2,EF3,and EF4 groups decreased by 32%,33%,and 35%,respectively,under a three-point bending load.The IFS of the four finite element models increased with the working length of the plate,with EF1(76%)<EF2(107%)<EF3(110%)<EF4(122%).Finite element analysis revealed that under full weight-bearing conditions,the structural stiffness of the femoral LCP external fixator decreased with increasing working length,leading to an increase in the IFS,which resulted in an IFS that exceeded the ideal range required for secondary healing.Conclusion For unstable lower tibial fractures,screws in the femoral LCP external fixator should be placed as close to the fracture end as possible to increase stability and promote fracture healing.
