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
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
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
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
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
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: 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
BACKGROUND Supracondylar humeral fractures(SCHF)are the second most common fractures in childhood and can lead to short-and long-term complications.Despite their prevalence,the anatomical factors that predispose child...BACKGROUND Supracondylar humeral fractures(SCHF)are the second most common fractures in childhood and can lead to short-and long-term complications.Despite their prevalence,the anatomical factors that predispose children to SCHF remain unclear.This study aimed to determine whether there are significant morpho-logical differences in the elbow by comparing the radiographic angular measure-ments of the contralateral elbows of patients with SCHF to those of patients with distal radius fractures(DRF)and a healthy control group.We sought to explore if these morphological variations contribute to the occurrence of SCHF.Radiographs of 78 SCHF patients were analyzed for angular measurements of the contralateral elbow.Two control groups were used:98 healthy children and 40 patients with DRF.Angular measurements included Baumann angle(BA),hu-meroulnar angle(HUA),humerus metaphysis-diaphysis angle(HMDA),humerus shaft-condylar angle(HSCA),and lateral capitellohumeral angle.Only BA,HUA,and HMDA were measured in the DRF group.Statistical analysis was performed to compare differences among groups.RESULTS Significant differences were found in elbow measurements between SCHF and control groups(P<0.05).However,the mean values for all groups fell within the ranges described in the literature.CONCLUSION While statistically significant differences were found in elbow morphology between SCHF patients and controls,these differences don't translate into clinically meaningful morphological deviations.展开更多
BACKGROUND Radial head fractures constitute approximately one-third of all elbow fractures,significantly impacting the young and active population.While open reduction and internal fixation is the preferred treatment ...BACKGROUND Radial head fractures constitute approximately one-third of all elbow fractures,significantly impacting the young and active population.While open reduction and internal fixation is the preferred treatment for displaced fractures,its high complication rate in comminuted fractures has led to the increasing use of radial head arthroplasty(RHA).RHA provides improved functional outcomes with fewer complications,yet its long-term efficacy remains a topic of debate.AIM To evaluate the functional outcomes of patients undergoing RHA with a modular metallic prosthesis for comminuted Mason type III and IV radial head fractures.METHODS A prospective and retrospective hospital-based study was conducted at Dayanand Medical College and Hospital,Ludhiana over 32 months(January 2021-August 2023).A total of 26 patients with Mason type III and IV fractures were included,with six retrospective and 20 prospective cases.Functional outcomes were assessed using the Mayo Elbow Performance Score(MEPS),elbow range of motion,pain via Visual Analog Scale,and activities of daily living at immediate postoperative,three-month,and six-month follow-ups.RESULTS MEPS at 6 months follow up for 4 cases(15.38%)had good scores,and 22 cases(84.62%)had excellent scores,with a mean±SD of 97.31±6.67.Comparisons showed significant improvement from immediate post-operative to 3 months(P<0.0001),from immediate post-operative to 6 months(P<0.0001),and between 3 months and 6 months(P<0.0001).None of the patients had elbow instability after radial head replacement and 22 cases(84.62%)had no complications,while 3 cases(11.54%)had a stiff elbow,and 1 case(3.85%)had heterotopic ossification.CONCLUSION RHA is an effective treatment for comminuted radial head fractures,providing stable elbow function with minimal complications.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
BACKGROUND Traumatic injuries,such as falling,car accidents,and crushing mostly cause spinal fractures in young and middle-aged people,and>50%of them are thoracolumbar fractures.This kind of fracture is easily comb...BACKGROUND Traumatic injuries,such as falling,car accidents,and crushing mostly cause spinal fractures in young and middle-aged people,and>50%of them are thoracolumbar fractures.This kind of fracture is easily combined with serious injuries to peripheral nerves and soft tissues,which causes paralysis of the lower limbs if there is no timely rehabilitation treatment.Young patients with thoracolumbar fractures find it difficult to recover after the operation,and they are prone to depression,low self-esteem,and other negative emotions.AIM To investigate the association between anxiety,depression,and social stress in young patients with thoracolumbar spine fractures and the effect on rehabilitation outcomes.METHODS This study retrospectively analyzed 100 patients admitted to the orthopedic department of Honghui Hospital,Xi’an Jiaotong University who underwent thoracolumbar spine fracture surgery from January 2022 to June 2023.The general data of the patients were assessed with the Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD),life events scale,and social support rating scale(SSRS)to identify the correlation between anxiety,depression scores,and social stress and social support.The Japanese Orthopedic Association(JOA)was utilized to evaluate the rehabilitation outcomes of the patients and to analyze the effects of anxiety and depression scores on rehabilitation.RESULTS According to the scores of HAMD and HAMA in all patients,the prevalence of depression in patients was 39%(39/100),and the prevalence of anxiety was 49%(49/100).Patients were categorized into non-depression(n=61)and depression(n=39),non-anxiety(n=51),and anxiety(n=49)groups.Statistically significant differences in gender,occupation,Pittsburgh Sleep Quality Index(PSQI)score,and monthly family income were observed between the non-depression and depression groups(P<0.05).A significant difference in occupation and PSQI score was found between the non-anxiety and anxiety groups.Both depression(r=0.207,P=0.038)and anxiety scores(r=0.473,P<0.001)were significantly and positively correlated with negative life events.The difference in negative life event scores as well as SSRS total and item scores was statist-ically significant between patients in the non-depression and depression groups(P<0.05).The difference between the non-anxiety and anxiety groups was statistically significant(P<0.05)in the negative life event scores as well as the total SSRS scores.Additionally,JOA scores were significantly lower in both anxious and depressed patients.CONCLUSION Young patients with thoracolumbar fractures are prone to anxiety and depression.Patients’anxiety and depression are closely associated with social pressure,which reduces the life pressure of young patients with thoracolumbar fractures,enhances social support,and improves the psychology of anxiety and depression.,which affects patients’recovery.展开更多
This article focuses on the factors influencing fracture nonunion, classification and treatment. The article emphasizes the importance of understanding the influencing factors and mechanisms of fracture healing for de...This article focuses on the factors influencing fracture nonunion, classification and treatment. The article emphasizes the importance of understanding the influencing factors and mechanisms of fracture healing for developing effective treatment strategies and improving patients’ quality of life. It also points out the challenges of current treatment, such as patient compliance and limitations of treatment methods, and looks at future treatment directions.展开更多
Hydraulic fracturing is a crucial technique for efficient development of coal reservoirs.Coal rocks typically contain a high density of natural fractures,which serve as conduits for fracturing fluid.Upon injection,the...Hydraulic fracturing is a crucial technique for efficient development of coal reservoirs.Coal rocks typically contain a high density of natural fractures,which serve as conduits for fracturing fluid.Upon injection,the fluid infiltrates these natural fractures and leaks out,resulting in complex fracture morphology.The prediction of hydraulic fracture network propagation for coal reservoirs has important practical significance for evaluating hydraulic fracturing.This study proposes a novel inversion method for predicting fracture networks in coal reservoirs,explicitly considering the distribution of natural fractures.The method incorporates three distinct natural fracture opening modes and employs a fractal probability function to constrain fracture propagationmorphology.Based on thismethod,the study compares hydraulic fracture networkmorphologies in coal reservoirs with andwithout the presence of natural fractures.Theresults showthatwhile both reservoir types exhibitmulti-branch fracture networks,reservoirs containing natural fractures demonstrate greater branching and a larger stimulated reservoir volume(SRV).Additionally,the study employs a fractal dimension calculation method to quantitatively describe the geometric distribution characteristics of fractures.The analysis reveals that the geometry and distribution of natural fractures,as well as reservoir geological parameters,significantly influence the fracture networkmorphology and fractal dimension.The contact angle between natural and hydraulic fractures affects propagation direction;specifically,when the contact angle isπ/2,the fractal dimension of the hydraulic fracture network is maximized.Moreover,smaller lengths and spacings of natural fracture led to higher fractal dimensions,which can significantly increase the SRV.The proposed method offers an effective tool for evaluating the hydraulic fracturing of coal reservoirs.展开更多
Despite extensive research on computational geomechanics and fluid dynamics,accurately simulating convection-diffusion(CD)processes in complex fractured systems remains a significant challenge.This study develops a 3D...Despite extensive research on computational geomechanics and fluid dynamics,accurately simulating convection-diffusion(CD)processes in complex fractured systems remains a significant challenge.This study develops a 3D numerical framework for modelling CD processes in fractured geological media.The framework integrates Darcy's law and Fick's law,considering flux interactions between the matrix and fractures.The meshing strategy generates high-quality grids even in scenarios involving intersecting fractures.Then,a unified numerical scheme for solving the CD system is proposed.The novelties of this work include:(1)The proposed framework enables effective simulation of 3D fractured media,including more complex fractured vuggy media;(2)The numerical method precisely discretizes the CD terms in governing equations;(3)A Non-Orthogonal Correction(NOC)method,combined with an adaptive time integration scheme,is proposed for eliminating errors induced by skewed grids;and(4)The effects of fracture patterns and heterogeneity on flow are thoroughly analysed.The proposed method is validated through benchmark tests,demonstrating the superiority of the NOC method compared to classical methods.Further analysis reveals the evolution characteristics of pressure and concentration,offering insights into the effects of fracture patterns and heterogeneity on flow and diffusion processes.展开更多
Prophylactic fixation(ProFix)of the proximal femur in elderly patients with osteoporosis presents a forward-thinking approach to preventing debilitating fractures and their associated complications.By addressing fract...Prophylactic fixation(ProFix)of the proximal femur in elderly patients with osteoporosis presents a forward-thinking approach to preventing debilitating fractures and their associated complications.By addressing fracture risk before an injury occurs,ProFix has the potential to enhance patient outcomes,promote long-term mobility,and reduce healthcare costs.Early intervention in individuals at high risk can significantly lower hospital admissions,shorten recovery periods,and preserve independence,mitigating challenges such as chronic pain and reduced life expectancy.Given the high prevalence of undiagnosed osteoporosis,prioritising early risk assessment and targeted prevention is essential.Advancements in minimally invasive surgical techniques and safer anaesthesia methods further support ProFix as a feasible and effective strategy to decrease fracturerelated morbidity,improve overall patient well-being,and optimise the use of healthcare resources.This opinion review details the evidence supporting this concept,its efficacy,the challenges in its implementation,and a strategic plan for future implementation.展开更多
A DFN-DEC(discrete fracture network-distinct element code)method based on the MATLAB platform is developed to generate heterogeneous DFN.Subsequently,the effects of the spatial variability(the meanμand the standard d...A DFN-DEC(discrete fracture network-distinct element code)method based on the MATLAB platform is developed to generate heterogeneous DFN.Subsequently,the effects of the spatial variability(the meanμand the standard deviationσ)of the geometric properties(i.e.,the fracture dip D,the trace length T and the spacing S)of both the gently-dipping(denoted with 1)and the steeply-dipping(denoted with 2)fractures on the stability of granite slope are investigated.Results indicate that the proposed DFN-DEC method is robust,generating fracture networks that resemble reality.In addition,the spatial variability of fracture geometry,influencing the structure of granite slope,plays a significant role in slope stability.The mean stability of the slope decreases with the increase ofμ_(D_(1))(the mean of gently-dipping fracture dip),σ_(D_(2))(the mean of steeply-dipping fracture dip),μ_(T_(1))(the mean of gently-dipping fracture trace length),μ_(T_(2))(the mean of steeply-dipping fracture trace length),σ_(T_(1))(the standard deviation of gently-dipping fracture trace length),σ_(T_(2))(the standard deviation of steeply-dipping fracture trace length),and the decrease ofσ_(D_(1))(the standard deviation of gently-dipping fracture dip),μ_(D_(2))(the standard deviation of steeply-dipping fracture dip),μ_(S_(1))(the mean of gently-dipping fracture spacing)andμ_(S_(2))(the mean of steeply-dipping fracture spacing).Among them,μ_(T_(1)),μ_(D_(1))andμ_(S_(1))have the major impact.When the fracture spacing is large,the variability in the fracture geometry becomes less relevant to slope stability.When within some ranges of the fracture spacing,the spatial varying of dips can increase the slope stability by forming an interlaced structure.The results also show that the effects of the variability of trace length on slope stability depend on the variability of dip.These findings highlight the importance of spatial variability in the geometry of fractures to rock slope stability analysis.展开更多
BACKGROUND Osteoporotic fractures,whether due to postmenopausal or senile causes,impose a significant financial burden on developing countries and diminish quality of life.Recent advancements in artificial intelligenc...BACKGROUND Osteoporotic fractures,whether due to postmenopausal or senile causes,impose a significant financial burden on developing countries and diminish quality of life.Recent advancements in artificial intelligence(AI)algorithms have demonstrated immense potential in predicting osteoporotic fractures.AIM To assess and compare the efficacy of AI models against dual-energy X-ray absorptiometry(DXA)and the Fracture Risk Assessment Tool(FRAX)in predicting fragility fractures.METHODS We conducted a literature search in English using electronic databases,including PubMed,Web of Science,and Scopus,for studies published until May 2024.The keywords employed were fragility fractures,osteoporosis,AI,deep learning,machine learning,and convolutional neural network.The inclusion criteria for selecting publications were based on studies involving patients with proximal femur and vertebral column fractures due to osteoporosis,utilizing AI algorithms,and analyzing the site of fracture and accuracy for predicting fracture risk using SPSS version 29(Chicago,IL,United States).RESULTS We identified 156 publications for analysis.After applying our inclusion criteria,24489 patients were analyzed from 13 studies.The mean area under the receiver operating characteristic curve was 0.925±0.69.The mean sensitivity was 68.3%±15.3%,specificity was 85.5%±13.4%,and positive predictive value was 86.5%±6.3%.DXA showed a sensitivity of 37.0% and 74.0%,while FRAX demonstrated a sensitivity of 45.7%and 84.7%.The P value for sensitivity between DXA and AI was<0.0001,while for FRAX it was<0.0001 and 0.2.CONCLUSION This review found that AI is a valuable tool to analyze and identify patients who will suffer from fragility fractures before they occur,demonstrating superiority over DXA and FRAX.Further studies are necessary to be conducted across various centers with diverse population groups,larger datasets,and a longer duration of follow-up to enhance the predictive performance of the AI models before their universal application.展开更多
Biodegradable magnesium(Mg)materials offer significant advantages in trauma care due to their degradable nature and superior mechanical properties.This study reports the first successful use of degradable Mg clips in ...Biodegradable magnesium(Mg)materials offer significant advantages in trauma care due to their degradable nature and superior mechanical properties.This study reports the first successful use of degradable Mg clips in damage control surgery for pelvic fractures,addressing challenges associated with severe hemorrhage and high mortality rates(30-70%).A 57-year-old male patient with pelvic fractures and traumatic shock underwent open reduction and internal fixation with Mg clips.At a six-month follow-up,imaging confirmed fracture healing,clip degradation,and no signs of rebleeding or infection,highlighting their effectiveness in precise hemorrhage control.Unlike traditional titanium clips,Mg clips degrade over time,eliminating the need for removal and reducing infection risks.This innovative approach combines Mg clips with conventional gauze packing,offering a more effective and safer alternative for managing pelvic trauma.Future large-scale clinical trials are necessary to validate these findings and establish Mg clips as a global standard for pelvic fracture treatment.Their portability and functionality hold promise for advancing emergency trauma care.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.
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.
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.
文摘BACKGROUND Supracondylar humeral fractures(SCHF)are the second most common fractures in childhood and can lead to short-and long-term complications.Despite their prevalence,the anatomical factors that predispose children to SCHF remain unclear.This study aimed to determine whether there are significant morpho-logical differences in the elbow by comparing the radiographic angular measure-ments of the contralateral elbows of patients with SCHF to those of patients with distal radius fractures(DRF)and a healthy control group.We sought to explore if these morphological variations contribute to the occurrence of SCHF.Radiographs of 78 SCHF patients were analyzed for angular measurements of the contralateral elbow.Two control groups were used:98 healthy children and 40 patients with DRF.Angular measurements included Baumann angle(BA),hu-meroulnar angle(HUA),humerus metaphysis-diaphysis angle(HMDA),humerus shaft-condylar angle(HSCA),and lateral capitellohumeral angle.Only BA,HUA,and HMDA were measured in the DRF group.Statistical analysis was performed to compare differences among groups.RESULTS Significant differences were found in elbow measurements between SCHF and control groups(P<0.05).However,the mean values for all groups fell within the ranges described in the literature.CONCLUSION While statistically significant differences were found in elbow morphology between SCHF patients and controls,these differences don't translate into clinically meaningful morphological deviations.
文摘BACKGROUND Radial head fractures constitute approximately one-third of all elbow fractures,significantly impacting the young and active population.While open reduction and internal fixation is the preferred treatment for displaced fractures,its high complication rate in comminuted fractures has led to the increasing use of radial head arthroplasty(RHA).RHA provides improved functional outcomes with fewer complications,yet its long-term efficacy remains a topic of debate.AIM To evaluate the functional outcomes of patients undergoing RHA with a modular metallic prosthesis for comminuted Mason type III and IV radial head fractures.METHODS A prospective and retrospective hospital-based study was conducted at Dayanand Medical College and Hospital,Ludhiana over 32 months(January 2021-August 2023).A total of 26 patients with Mason type III and IV fractures were included,with six retrospective and 20 prospective cases.Functional outcomes were assessed using the Mayo Elbow Performance Score(MEPS),elbow range of motion,pain via Visual Analog Scale,and activities of daily living at immediate postoperative,three-month,and six-month follow-ups.RESULTS MEPS at 6 months follow up for 4 cases(15.38%)had good scores,and 22 cases(84.62%)had excellent scores,with a mean±SD of 97.31±6.67.Comparisons showed significant improvement from immediate post-operative to 3 months(P<0.0001),from immediate post-operative to 6 months(P<0.0001),and between 3 months and 6 months(P<0.0001).None of the patients had elbow instability after radial head replacement and 22 cases(84.62%)had no complications,while 3 cases(11.54%)had a stiff elbow,and 1 case(3.85%)had heterotopic ossification.CONCLUSION RHA is an effective treatment for comminuted radial head fractures,providing stable elbow function with minimal complications.
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BACKGROUND Traumatic injuries,such as falling,car accidents,and crushing mostly cause spinal fractures in young and middle-aged people,and>50%of them are thoracolumbar fractures.This kind of fracture is easily combined with serious injuries to peripheral nerves and soft tissues,which causes paralysis of the lower limbs if there is no timely rehabilitation treatment.Young patients with thoracolumbar fractures find it difficult to recover after the operation,and they are prone to depression,low self-esteem,and other negative emotions.AIM To investigate the association between anxiety,depression,and social stress in young patients with thoracolumbar spine fractures and the effect on rehabilitation outcomes.METHODS This study retrospectively analyzed 100 patients admitted to the orthopedic department of Honghui Hospital,Xi’an Jiaotong University who underwent thoracolumbar spine fracture surgery from January 2022 to June 2023.The general data of the patients were assessed with the Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD),life events scale,and social support rating scale(SSRS)to identify the correlation between anxiety,depression scores,and social stress and social support.The Japanese Orthopedic Association(JOA)was utilized to evaluate the rehabilitation outcomes of the patients and to analyze the effects of anxiety and depression scores on rehabilitation.RESULTS According to the scores of HAMD and HAMA in all patients,the prevalence of depression in patients was 39%(39/100),and the prevalence of anxiety was 49%(49/100).Patients were categorized into non-depression(n=61)and depression(n=39),non-anxiety(n=51),and anxiety(n=49)groups.Statistically significant differences in gender,occupation,Pittsburgh Sleep Quality Index(PSQI)score,and monthly family income were observed between the non-depression and depression groups(P<0.05).A significant difference in occupation and PSQI score was found between the non-anxiety and anxiety groups.Both depression(r=0.207,P=0.038)and anxiety scores(r=0.473,P<0.001)were significantly and positively correlated with negative life events.The difference in negative life event scores as well as SSRS total and item scores was statist-ically significant between patients in the non-depression and depression groups(P<0.05).The difference between the non-anxiety and anxiety groups was statistically significant(P<0.05)in the negative life event scores as well as the total SSRS scores.Additionally,JOA scores were significantly lower in both anxious and depressed patients.CONCLUSION Young patients with thoracolumbar fractures are prone to anxiety and depression.Patients’anxiety and depression are closely associated with social pressure,which reduces the life pressure of young patients with thoracolumbar fractures,enhances social support,and improves the psychology of anxiety and depression.,which affects patients’recovery.
文摘This article focuses on the factors influencing fracture nonunion, classification and treatment. The article emphasizes the importance of understanding the influencing factors and mechanisms of fracture healing for developing effective treatment strategies and improving patients’ quality of life. It also points out the challenges of current treatment, such as patient compliance and limitations of treatment methods, and looks at future treatment directions.
基金This study was supported by the Foundation of National Engineering Laboratory for Exploration and Development of Low-Permeability Oil and Gas Fields(2023-015).
文摘Hydraulic fracturing is a crucial technique for efficient development of coal reservoirs.Coal rocks typically contain a high density of natural fractures,which serve as conduits for fracturing fluid.Upon injection,the fluid infiltrates these natural fractures and leaks out,resulting in complex fracture morphology.The prediction of hydraulic fracture network propagation for coal reservoirs has important practical significance for evaluating hydraulic fracturing.This study proposes a novel inversion method for predicting fracture networks in coal reservoirs,explicitly considering the distribution of natural fractures.The method incorporates three distinct natural fracture opening modes and employs a fractal probability function to constrain fracture propagationmorphology.Based on thismethod,the study compares hydraulic fracture networkmorphologies in coal reservoirs with andwithout the presence of natural fractures.Theresults showthatwhile both reservoir types exhibitmulti-branch fracture networks,reservoirs containing natural fractures demonstrate greater branching and a larger stimulated reservoir volume(SRV).Additionally,the study employs a fractal dimension calculation method to quantitatively describe the geometric distribution characteristics of fractures.The analysis reveals that the geometry and distribution of natural fractures,as well as reservoir geological parameters,significantly influence the fracture networkmorphology and fractal dimension.The contact angle between natural and hydraulic fractures affects propagation direction;specifically,when the contact angle isπ/2,the fractal dimension of the hydraulic fracture network is maximized.Moreover,smaller lengths and spacings of natural fracture led to higher fractal dimensions,which can significantly increase the SRV.The proposed method offers an effective tool for evaluating the hydraulic fracturing of coal reservoirs.
基金financially supported by the National Natural Science Foundation of China(Grant Nos.51991392 and 42293355).
文摘Despite extensive research on computational geomechanics and fluid dynamics,accurately simulating convection-diffusion(CD)processes in complex fractured systems remains a significant challenge.This study develops a 3D numerical framework for modelling CD processes in fractured geological media.The framework integrates Darcy's law and Fick's law,considering flux interactions between the matrix and fractures.The meshing strategy generates high-quality grids even in scenarios involving intersecting fractures.Then,a unified numerical scheme for solving the CD system is proposed.The novelties of this work include:(1)The proposed framework enables effective simulation of 3D fractured media,including more complex fractured vuggy media;(2)The numerical method precisely discretizes the CD terms in governing equations;(3)A Non-Orthogonal Correction(NOC)method,combined with an adaptive time integration scheme,is proposed for eliminating errors induced by skewed grids;and(4)The effects of fracture patterns and heterogeneity on flow are thoroughly analysed.The proposed method is validated through benchmark tests,demonstrating the superiority of the NOC method compared to classical methods.Further analysis reveals the evolution characteristics of pressure and concentration,offering insights into the effects of fracture patterns and heterogeneity on flow and diffusion processes.
文摘Prophylactic fixation(ProFix)of the proximal femur in elderly patients with osteoporosis presents a forward-thinking approach to preventing debilitating fractures and their associated complications.By addressing fracture risk before an injury occurs,ProFix has the potential to enhance patient outcomes,promote long-term mobility,and reduce healthcare costs.Early intervention in individuals at high risk can significantly lower hospital admissions,shorten recovery periods,and preserve independence,mitigating challenges such as chronic pain and reduced life expectancy.Given the high prevalence of undiagnosed osteoporosis,prioritising early risk assessment and targeted prevention is essential.Advancements in minimally invasive surgical techniques and safer anaesthesia methods further support ProFix as a feasible and effective strategy to decrease fracturerelated morbidity,improve overall patient well-being,and optimise the use of healthcare resources.This opinion review details the evidence supporting this concept,its efficacy,the challenges in its implementation,and a strategic plan for future implementation.
基金supported by the National Natural Science Foundation of China(Nos.41807264,41972289)the Engineering Research Center of Rock-Soil Drilling&Excavation and Protection,Ministry of Education(No.202102)+3 种基金the Key Laboratory of Geological Hazards on Three Gorges Reservoir Area(China Three Gorges University),Ministry of Education(No.2020KDZ01)the Fundamental Research Funds for the Central Universities,China University of Geosciences(Wuhan)(Nos.CUG170686,CUGQY1932)the China Scholarship Council(No.201406410032)the Science and Technology Research Project of Education Department of Hubei Province(Nos.B2019452,B2024509)。
文摘A DFN-DEC(discrete fracture network-distinct element code)method based on the MATLAB platform is developed to generate heterogeneous DFN.Subsequently,the effects of the spatial variability(the meanμand the standard deviationσ)of the geometric properties(i.e.,the fracture dip D,the trace length T and the spacing S)of both the gently-dipping(denoted with 1)and the steeply-dipping(denoted with 2)fractures on the stability of granite slope are investigated.Results indicate that the proposed DFN-DEC method is robust,generating fracture networks that resemble reality.In addition,the spatial variability of fracture geometry,influencing the structure of granite slope,plays a significant role in slope stability.The mean stability of the slope decreases with the increase ofμ_(D_(1))(the mean of gently-dipping fracture dip),σ_(D_(2))(the mean of steeply-dipping fracture dip),μ_(T_(1))(the mean of gently-dipping fracture trace length),μ_(T_(2))(the mean of steeply-dipping fracture trace length),σ_(T_(1))(the standard deviation of gently-dipping fracture trace length),σ_(T_(2))(the standard deviation of steeply-dipping fracture trace length),and the decrease ofσ_(D_(1))(the standard deviation of gently-dipping fracture dip),μ_(D_(2))(the standard deviation of steeply-dipping fracture dip),μ_(S_(1))(the mean of gently-dipping fracture spacing)andμ_(S_(2))(the mean of steeply-dipping fracture spacing).Among them,μ_(T_(1)),μ_(D_(1))andμ_(S_(1))have the major impact.When the fracture spacing is large,the variability in the fracture geometry becomes less relevant to slope stability.When within some ranges of the fracture spacing,the spatial varying of dips can increase the slope stability by forming an interlaced structure.The results also show that the effects of the variability of trace length on slope stability depend on the variability of dip.These findings highlight the importance of spatial variability in the geometry of fractures to rock slope stability analysis.
文摘BACKGROUND Osteoporotic fractures,whether due to postmenopausal or senile causes,impose a significant financial burden on developing countries and diminish quality of life.Recent advancements in artificial intelligence(AI)algorithms have demonstrated immense potential in predicting osteoporotic fractures.AIM To assess and compare the efficacy of AI models against dual-energy X-ray absorptiometry(DXA)and the Fracture Risk Assessment Tool(FRAX)in predicting fragility fractures.METHODS We conducted a literature search in English using electronic databases,including PubMed,Web of Science,and Scopus,for studies published until May 2024.The keywords employed were fragility fractures,osteoporosis,AI,deep learning,machine learning,and convolutional neural network.The inclusion criteria for selecting publications were based on studies involving patients with proximal femur and vertebral column fractures due to osteoporosis,utilizing AI algorithms,and analyzing the site of fracture and accuracy for predicting fracture risk using SPSS version 29(Chicago,IL,United States).RESULTS We identified 156 publications for analysis.After applying our inclusion criteria,24489 patients were analyzed from 13 studies.The mean area under the receiver operating characteristic curve was 0.925±0.69.The mean sensitivity was 68.3%±15.3%,specificity was 85.5%±13.4%,and positive predictive value was 86.5%±6.3%.DXA showed a sensitivity of 37.0% and 74.0%,while FRAX demonstrated a sensitivity of 45.7%and 84.7%.The P value for sensitivity between DXA and AI was<0.0001,while for FRAX it was<0.0001 and 0.2.CONCLUSION This review found that AI is a valuable tool to analyze and identify patients who will suffer from fragility fractures before they occur,demonstrating superiority over DXA and FRAX.Further studies are necessary to be conducted across various centers with diverse population groups,larger datasets,and a longer duration of follow-up to enhance the predictive performance of the AI models before their universal application.
基金supported by grants from the Integrated Traditional Chinese and Western Medicine Guidance Project for General Hospitals of Shanghai Municipal Health Commission(ZXXT-202311)the National Key R&D Program of China(No.2023YFC2416800)+1 种基金the National Natural Science Foundation of China(No.52201300)the Fundamental Research Funds for the Central Universities(No.2232024D-34).
文摘Biodegradable magnesium(Mg)materials offer significant advantages in trauma care due to their degradable nature and superior mechanical properties.This study reports the first successful use of degradable Mg clips in damage control surgery for pelvic fractures,addressing challenges associated with severe hemorrhage and high mortality rates(30-70%).A 57-year-old male patient with pelvic fractures and traumatic shock underwent open reduction and internal fixation with Mg clips.At a six-month follow-up,imaging confirmed fracture healing,clip degradation,and no signs of rebleeding or infection,highlighting their effectiveness in precise hemorrhage control.Unlike traditional titanium clips,Mg clips degrade over time,eliminating the need for removal and reducing infection risks.This innovative approach combines Mg clips with conventional gauze packing,offering a more effective and safer alternative for managing pelvic trauma.Future large-scale clinical trials are necessary to validate these findings and establish Mg clips as a global standard for pelvic fracture treatment.Their portability and functionality hold promise for advancing emergency trauma care.
