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
Prepulse combined hydraulic fracturing facilitates the development of fracture networks by integrating prepulse hydraulic loading with conventional hydraulic fracturing.The formation mechanisms of fracture networks be...Prepulse combined hydraulic fracturing facilitates the development of fracture networks by integrating prepulse hydraulic loading with conventional hydraulic fracturing.The formation mechanisms of fracture networks between hydraulic and pre-existing fractures under different prepulse loading parameters remain unclear.This research investigates the impact of prepulse loading parameters,including the prepulse loading number ratio(C),prepulse loading stress ratio(S),and prepulse loading frequency(f),on the formation of fracture networks between hydraulic and pre-existing fractures,using both experimental and numerical methods.The results suggest that low prepulse loading stress ratios and high prepulse loading number ratios are advantageous loading modes.Multiple hydraulic fractures are generated in the specimen under the advantageous loading modes,facilitating the development of a complex fracture network.Fatigue damage occurs in the specimen at the prepulse loading stage.The high water pressure at the secondary conventional hydraulic fracturing promotes the growth of hydraulic fractures along the damage zones.This allows the hydraulic fractures to propagate deeply and interact with pre-existing fractures.Under advantageous loading conditions,multiple hydraulic fractures can extend to pre-existing fractures,and these hydraulic fractures penetrate or propagate along pre-existing fractures.Especially when the approach angle is large,the damage range in the specimen during the prepulse loading stage increases,resulting in the formation of more hydraulic fractures.展开更多
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
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
Background and Objectives: The distal radius fracture (DRF) is a major public health problem in northern countries. Its frequency is constantly increasing. The locked anterior plate with its well-established biomechan...Background and Objectives: The distal radius fracture (DRF) is a major public health problem in northern countries. Its frequency is constantly increasing. The locked anterior plate with its well-established biomechanical properties, offers a reliable alternative. The aim of this study was to evaluate the radiological, the functional results and to determine the factors of poor postoperative prognosis of DRF treated with Newclip radial plates®. Methodology: This prospective cohort study evaluates the radiological and functional outcames of displaced radius fractures (DRFs) in patients ≥50 years old treated with Newclip® (locked anterior plates) at the Basse-Terre Hospital in Guadeloupe from 2022 to 2024. The patients were categorized into those with epiphyseal involvement (E1 - E4) and without epiphyseal involvement (E0) based on Laulan’s MEU classification. Radiological parameters (distal radio-ulnar index (DRUI), radial inclination frant view (IRF), radial inclination sagittal view (IRS) were assessed pre and post-operatively. Functional recovery was evaluated at 12 months using the QuickDash questionnaire. Results: Falls were the most common cause of fracture. Post-operatively, SRI was the least restored parameter. Poor prognostic factor for SRI improvement included posterior commimution and unstable fractures. Factors associated with higher QuickDash scores included unstable factures, unrestored DRUI, low plate position, metaphyseal features, and ulnar features. Conclusion: The anterior locking plate osteosynthesis is reliable treatment option with excellent functional outcomes.展开更多
Controllable shock wave fracturing is an innovative engineering technique used for shale reservoir fracturing and reformation.Understanding the anisotropic fracture mechanism of shale under impact loading is vital for...Controllable shock wave fracturing is an innovative engineering technique used for shale reservoir fracturing and reformation.Understanding the anisotropic fracture mechanism of shale under impact loading is vital for optimizing shock wave fracturing equipment and enhancing shale oil production.In this study,using the well-known notched semi-circular bend(NSCB)sample and the novel double-edge notched flattened Brazilian disc(DNFBD)sample combined with a split Hopkinson pressure bar(SHPB),various dynamic anisotropic fracture properties of Lushan shale,including failure characteristics,fracture toughness,energy dissipation and crack propagation velocity,are comprehensively compared and discussed under mode Ⅰ and mode Ⅱ fracture scenarios.First,using a newly modified fracture criterion considering the strength anisotropy of shale,the DNFBD specimen is predicted to be a robust method for true mode Ⅱ fracture of anisotropic shale rocks.Our experimental results show that the dynamic mode Ⅱ fracture of shale induces a rougher and more complex fracture morphology and performs a higher fracture toughness or fracture energy compared to dynamic mode Ⅰ fracture.The minimal fracture toughness or fracture energy occurs in the Short-transverse orientation,while the maximal ones occur in the Divider orientation.In addition,it is interesting to find that the mode Ⅱ fracture toughness anisotropy index decreases more slowly than that in the mode Ⅰ fracture scenario.These results provide significant insights for understanding the different dynamic fracture mechanisms of anisotropic shale rocks under impact loading and have some beneficial implications for the controllable shock wave fracturing technique.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
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
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 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
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
This editorial critically evaluates the landmark study by Tanaka and Yoshii,which demonstrated a 100%union rate with conservative management of hamate hook fractures,challenging the historical preference for surgical ...This editorial critically evaluates the landmark study by Tanaka and Yoshii,which demonstrated a 100%union rate with conservative management of hamate hook fractures,challenging the historical preference for surgical intervention.In contrast to Scheufle et al’s report of 90%-100%failure rates with early surgical approaches,Tanaka and Yoshii’s protocol achieved universal healing despite delayed diagnoses in 25%of cases.Central to this success is the systematic inte-gration of high-resolution computed tomography for early diagnosis and dynamic monitoring of trabecular bone regeneration,significantly reducing missed dia-gnoses and guiding personalized immobilization timelines.The patient-centered strategy—allowing temporary splint removal during low-risk activities—balanced fracture stability with joint mobility preservation,avoiding post-treatment stiff-ness.However,limitations such as small sample size(n=16),selection bias,and insufficient long-term functional data(e.g.,grip strength,return-to-sport metrics)underscore the need for comparative trials.Emerging trends,including adjunct therapies like low-intensity pulsed ultrasound and biologics(e.g.,teriparatide),are proposed to accelerate healing while minimizing immobilization risks.This work redefines conservative fracture management paradigms,emphasizing in-novation without compromising efficacy.Overall,this assessment deepens our understanding of the conservative management of hook fractures and provides evidence-based insights for improved clinical decision-making.展开更多
Hydraulic fracture growth is significantly influenced by the minimum horizontal principal stress gradient and the fracturing fluid pressure gradient.However,these gradients are often neglected in scaled physical model...Hydraulic fracture growth is significantly influenced by the minimum horizontal principal stress gradient and the fracturing fluid pressure gradient.However,these gradients are often neglected in scaled physical modeling experiments due to difficulties in reproducing them.This study uses centrifugal hypergravity to simulate both gradients and investigate their effects on fracture propagation.Artificial mortar specimens(ϕ200 mm×400 mm)are fractured under 1g(normal gravity),50g,and 100g.Results show that compared to 1g,fractures under 50g and 100g exhibit increasingly uneven propagation,with higher g-values leading to greater asymmetry.To interpret this,a theoretical analysis based on fracture mechanics is conducted.When the fluid pressure gradient exceeds the stress gradient,a positive net gradient is generated,increasing net pressure at the lower fracture tip.This raises the stress intensity factor at the lower tip,promoting downward growth.As g increases,the disparity becomes more significant,resulting in greater fracture deviation.In conclusion,this study,for the first time,has verified and explained that the net gradient can change the propagation of hydraulic fractures,providing important guidance for wellbore placement under stress gradients.展开更多
To compare the clinical efficacy of locking plate(LP)fixation and intramedullary nail(IMN)fixation for the treatment of post-traumatic nonunion of diaphyseal fractures of the femur and tibia.Methods:This single-center...To compare the clinical efficacy of locking plate(LP)fixation and intramedullary nail(IMN)fixation for the treatment of post-traumatic nonunion of diaphyseal fractures of the femur and tibia.Methods:This single-center retrospective comparative study included 50 adult patients with aseptic nonunion of femoral or tibial diaphyseal fractures treated at our institution between January 2015 and January 2025.Patients underwent either locking-plate(LP)fixation(n=25)or intramedullary nailing(IMN)(n=25).The primary outcome was radiographic union at 12 months postoperatively.Secondary outcomes included time to union,operative time,intraoperative blood loss,length of hospital stay,incidence of complications(superficial/deep infection,implant failure,malunion),and 12-month functional status assessed by the Lower Extremity Functional Scale(LEFS).Statistical comparisons used Welch t tests for continuous variables and χ^(2) or Fisher exact tests for categorical variables.The protocol received institutional review board approval with waiver of informed consent.Results:Among 50 patients(LP=25;IMN=25),the 12-month union rate was 88.00%(22/25)in the LP group and 96.00%(24/25)in the IMN group(p=0.609).Time to union was shorter with IMN(6.20±1.83 vs 7.51±2.12 months;p=0.023).Operative time(110.52±25.23 vs 145.81±30.21 min;p<0.01)and intraoperative blood loss(250.41±80.64 vs 350.22±95.30 ml;p<0.01)favored IMN.Length of hospital stay was similar(6.24±1.83 vs 6.82±2.11 days;p=0.284).The incidence of superficial wound infection did not differ significantly(12.00%vs 4.00%;p=0.609).Twelve-month LEFS scores were comparable(65.44±10.21 vs 67.10±9.83;p=0.451).Conclusion:Both locking plate and intramedullary nail fixation are effective in the treatment of femoral and tibial nonunion,with high rates of union and good functional outcomes.Intramedullary nailing may be associated with a shorter time to union,reduced operative time and blood loss,and a lower risk of superficial wound infection compared to locking plate fixation.The choice of implant should be individualized based on fracture characteristics,patient factors,and surgeon preference.展开更多
Epiphyseal fracture is a significant etiology of limb deformity in children following fractures.However,unlike the rapid advancements in orthopedics,progress regarding the pathological changes,diagnosis,and treatment ...Epiphyseal fracture is a significant etiology of limb deformity in children following fractures.However,unlike the rapid advancements in orthopedics,progress regarding the pathological changes,diagnosis,and treatment of epi-physeal fractures has been slow.This review provides an overview of the epide-miology and classification of epiphyseal fractures,as well as the post-fracture pathological changes occurring within the epiphysis and its surrounding areas.Furthermore,it reviews recent advancements in the treatment of epiphyseal fractures.By summarizing laboratory-to-clinical progress related to this type of fracture,this article aims to assist pediatric orthopedists in accurately recognizing,diagnosing,and treating such injuries.展开更多
The mineralogy and texture of granite have been found to have a pronounced effect on its mechanical behavior.However,the precise manner in which the texture of granite affects the shear behavior of fractures remains e...The mineralogy and texture of granite have been found to have a pronounced effect on its mechanical behavior.However,the precise manner in which the texture of granite affects the shear behavior of fractures remains enigmatic.In this study,fine-grained granite(FG)and coarse-grained granite(CG)were used to create tensile fractures with surface roughness(i.e.joint roughness coefficient(JRC))within the range of 5.48-8.34 and 12.68-16.5,respectively.The pre-fractured specimens were then subjected to direct shear tests under normal stresses of 1-30 MPa.The results reveal that shear strengths are smaller and stick-slip behaviors are more intense for FG fractures than for CG fractures,which is attributed to the different conditions of the shear surface constrained by the grain size.The smaller grain size in FG contributes to the smoother fracture surface and lower shear strength.The negative friction rate parameter a-b for both CG and FG fractures and the larger shear stiffness for FG than for CG fractures can account for the more intense stick-slip behaviors in FG fractures.The relative crack density for the post-shear CG fractures is greater than that of the FG fractures under the same normal stress,both of which decrease with the distance away from the shear surface following the power law.Moreover,the damage of CG fracture extends to a larger extent beneath the surface compared with the FG fracture.Our findings demonstrate that the grain size of the host rock exerts a significant influence on the fracture roughness,and thus should be incorporated into the assessment of fault slip behavior to better understand the role of mineralogy and texture in seismic activities.展开更多
BACKGROUND Clavicle fractures are a common type of fracture that often occurs after high-energy trauma.The treatment methods for clavicle fractures remain controversial.Both locking compression and hook plates are rec...BACKGROUND Clavicle fractures are a common type of fracture that often occurs after high-energy trauma.The treatment methods for clavicle fractures remain controversial.Both locking compression and hook plates are recommended.CASE SUMMARY A 44-year-old male suffered an injury during skiing.Radiography revealed a right-sided distal clavicular fracture.The fracture was treated using a hook plate due to its small size.During the surgical procedure,Kirschner wires were used to drill holes in the acromion.The end of the hook plate was inserted into the hole rather than below the edge of the acromion.CONCLUSION One year later,imaging revealed complete healing of the fracture,and the hook plate was removed.The patient was satisfied with the course and treatment results.Additionally,a new classification system was proposed based on the degree of injury to the distal clavicle joint surface.The incidence of postoperative complications associated with the use of hook plates for clavicular fracture treatment is relatively high.Complications can be reduced by changing the hook plate placement.展开更多
To evaluate the thermal behavior of tunnels,an equivalent thermal conductivity(ETC)model for the fractured rock masses surrounding tunnels was proposed,based on the series-parallel theory,which incorporates the heat t...To evaluate the thermal behavior of tunnels,an equivalent thermal conductivity(ETC)model for the fractured rock masses surrounding tunnels was proposed,based on the series-parallel theory,which incorporates the heat transfer characteristics of the surrounding rock.A thermal probe test(TPT)was subsequently conducted at the Dajian Mountain Tunnel(China),and the heat transfer model of the thermal probe was developed and calibrated based on the TPT results.The ETCs of different test areas in the borehole were calculated based on the fracture parameters(dip direction,dip angle,opening,trace length),obtained via a digital borehole photography test.Finally,the new ETC model,the volumeaveraged model,and the non-fracture model were compared for accuracy in heat transfer calculation.The results demonstrate that(1)the error of heat transfer calculation error was reduced by 17.2%e69.2%using the new ETC model.(2)For the ETCs of different thermal response test areas,the minimum and maximum values were 2.15 W/(m K)and 3.7 W/(m K),respectively,with the fracture effect causing up to a 41.2%reduction in thermal conductivity.(3)For the ETC of the borehole,the ETC value was 2.53 W/(m K),with the fracture effect leading to a 31.6%reduction in thermal conductivity.The effect of fractures on the thermal conductivity of rock mass could not be ignored.This ETC model addresses the challenge of determining the ETC for the heterogeneous surrounding rock of tunnels and provides a more accurate representation of the in situ thermal behavior of tunnels.展开更多
The glutenite reservoir is strongly heterogeneous due to the random distribution of gravels, making it challenging to perform hydraulic fracturing effectively. To solve this issue, it is essential to study interaction...The glutenite reservoir is strongly heterogeneous due to the random distribution of gravels, making it challenging to perform hydraulic fracturing effectively. To solve this issue, it is essential to study interaction behavior between hydraulic fractures(HFs) and gravels. A coupled hydro-mechanical model is proposed for HF propagation in glutenite using a grain-based discrete element method. This paper first investigates the dynamic evolution of HFs in glutenite, then analyzes the influences of various factors such as horizontal stress difference(Δσ), minimum horizontal stress(σh), gravel content(Vg), gravel size(dg), and stiffness ratio of gravel to matrix(Rs) on HF propagation geometries. Results show that penetrating the gravel is the primary HF-gravel interaction behavior, which follows sequential and staggered initiation modes. Bypassing the gravel is the secondary behavior, which obeys the sequential initiation mode and occurs when the orientation of the gravel boundary is inclined to the maximum horizontal stress(σH). An offset along the gravel boundary is usually formed while penetrating gravels, and the offsets may cause fracture widths to decrease by 37.8%-84.4%. Even if stress dominates the direction of HF propagation, HFs still tend to deflect within gravels. The deviation angle from σH decreases with rising Δσand increases with the increase of dgand Rs. Additionally, intra-gravel shear HFs(IGS-HFs) are prone to be generated in coarse-grained glutenite under high Δσ, while more gravel-bypassing shear HFs(GBSHFs) tend to be created in argillaceous glutenite with high Rsthan in sandy glutenite with low Rs. The findings above prompt the emergence of a novel HF propagation pattern in glutenite, which helps to understand the real HF geometries and to provide theoretical guidance for treatments in the field.展开更多
文摘Complex trimalleolar ankle fractures are a major orthopaedic challenge,with an incidence of 4.22 per 10000 person-years in the United States and an annual cost of 3.4 billion dollars.This review synthesizes current evidence on diagnostic protocols and management strategies,highlighting optimal approaches and emerging trends.Initial care emphasizes soft tissue assessment,often guided by the Tscherne classification,and fracture classification systems.External fixation may be required in open injuries,while early open reduction and internal fixation within six days is linked to improved outcomes.Minimally invasive techniques for the lateral malleolus,including intramedullary nailing and locking plates,are effective,while medial malleolus fractures are commonly managed with screw fixation or tension-band wiring.Posterior malleolus fragments involving more than 25%of the articular surface usually warrant fixation.Alternatives to syndesmotic screws,such as cortical buttons or high-strength sutures,reduce the need for secondary procedures.Arthroscopic-assisted open reduction and internal fixation benefits younger,active patients by enabling concurrent management of intra-articular and ligamentous injuries.Postoperative care prioritizes early weight-bearing and validated functional scores.Despite advances,complications remain common,and further research is needed to refine surgical strategies and improve outcomes.
基金financially supported by,the Fundamental Research Funds for the Central Universities(Grant No.2023QN1064)the China Postdoctoral Science Foundation(Grant No.2023M733772)Jiangsu Funding Program for Excellent Postdoctoral Talent(Grant No.2023ZB847)。
文摘Prepulse combined hydraulic fracturing facilitates the development of fracture networks by integrating prepulse hydraulic loading with conventional hydraulic fracturing.The formation mechanisms of fracture networks between hydraulic and pre-existing fractures under different prepulse loading parameters remain unclear.This research investigates the impact of prepulse loading parameters,including the prepulse loading number ratio(C),prepulse loading stress ratio(S),and prepulse loading frequency(f),on the formation of fracture networks between hydraulic and pre-existing fractures,using both experimental and numerical methods.The results suggest that low prepulse loading stress ratios and high prepulse loading number ratios are advantageous loading modes.Multiple hydraulic fractures are generated in the specimen under the advantageous loading modes,facilitating the development of a complex fracture network.Fatigue damage occurs in the specimen at the prepulse loading stage.The high water pressure at the secondary conventional hydraulic fracturing promotes the growth of hydraulic fractures along the damage zones.This allows the hydraulic fractures to propagate deeply and interact with pre-existing fractures.Under advantageous loading conditions,multiple hydraulic fractures can extend to pre-existing fractures,and these hydraulic fractures penetrate or propagate along pre-existing fractures.Especially when the approach angle is large,the damage range in the specimen during the prepulse loading stage increases,resulting in the formation of more hydraulic fractures.
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.
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.
文摘Background and Objectives: The distal radius fracture (DRF) is a major public health problem in northern countries. Its frequency is constantly increasing. The locked anterior plate with its well-established biomechanical properties, offers a reliable alternative. The aim of this study was to evaluate the radiological, the functional results and to determine the factors of poor postoperative prognosis of DRF treated with Newclip radial plates®. Methodology: This prospective cohort study evaluates the radiological and functional outcames of displaced radius fractures (DRFs) in patients ≥50 years old treated with Newclip® (locked anterior plates) at the Basse-Terre Hospital in Guadeloupe from 2022 to 2024. The patients were categorized into those with epiphyseal involvement (E1 - E4) and without epiphyseal involvement (E0) based on Laulan’s MEU classification. Radiological parameters (distal radio-ulnar index (DRUI), radial inclination frant view (IRF), radial inclination sagittal view (IRS) were assessed pre and post-operatively. Functional recovery was evaluated at 12 months using the QuickDash questionnaire. Results: Falls were the most common cause of fracture. Post-operatively, SRI was the least restored parameter. Poor prognostic factor for SRI improvement included posterior commimution and unstable fractures. Factors associated with higher QuickDash scores included unstable factures, unrestored DRUI, low plate position, metaphyseal features, and ulnar features. Conclusion: The anterior locking plate osteosynthesis is reliable treatment option with excellent functional outcomes.
基金supported by the National Natural Science Foundation of China(Grant No.12302500)the National Key Research and Development Program of China(Grant No.2020YFA0710503)Postdoctoral Fellowship Program(Grade B)of China Postdoctoral Science Foundation(Grant No.GBZ20230022).
文摘Controllable shock wave fracturing is an innovative engineering technique used for shale reservoir fracturing and reformation.Understanding the anisotropic fracture mechanism of shale under impact loading is vital for optimizing shock wave fracturing equipment and enhancing shale oil production.In this study,using the well-known notched semi-circular bend(NSCB)sample and the novel double-edge notched flattened Brazilian disc(DNFBD)sample combined with a split Hopkinson pressure bar(SHPB),various dynamic anisotropic fracture properties of Lushan shale,including failure characteristics,fracture toughness,energy dissipation and crack propagation velocity,are comprehensively compared and discussed under mode Ⅰ and mode Ⅱ fracture scenarios.First,using a newly modified fracture criterion considering the strength anisotropy of shale,the DNFBD specimen is predicted to be a robust method for true mode Ⅱ fracture of anisotropic shale rocks.Our experimental results show that the dynamic mode Ⅱ fracture of shale induces a rougher and more complex fracture morphology and performs a higher fracture toughness or fracture energy compared to dynamic mode Ⅰ fracture.The minimal fracture toughness or fracture energy occurs in the Short-transverse orientation,while the maximal ones occur in the Divider orientation.In addition,it is interesting to find that the mode Ⅱ fracture toughness anisotropy index decreases more slowly than that in the mode Ⅰ fracture scenario.These results provide significant insights for understanding the different dynamic fracture mechanisms of anisotropic shale rocks under impact loading and have some beneficial implications for the controllable shock wave fracturing technique.
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.
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.
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 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.
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.
文摘This editorial critically evaluates the landmark study by Tanaka and Yoshii,which demonstrated a 100%union rate with conservative management of hamate hook fractures,challenging the historical preference for surgical intervention.In contrast to Scheufle et al’s report of 90%-100%failure rates with early surgical approaches,Tanaka and Yoshii’s protocol achieved universal healing despite delayed diagnoses in 25%of cases.Central to this success is the systematic inte-gration of high-resolution computed tomography for early diagnosis and dynamic monitoring of trabecular bone regeneration,significantly reducing missed dia-gnoses and guiding personalized immobilization timelines.The patient-centered strategy—allowing temporary splint removal during low-risk activities—balanced fracture stability with joint mobility preservation,avoiding post-treatment stiff-ness.However,limitations such as small sample size(n=16),selection bias,and insufficient long-term functional data(e.g.,grip strength,return-to-sport metrics)underscore the need for comparative trials.Emerging trends,including adjunct therapies like low-intensity pulsed ultrasound and biologics(e.g.,teriparatide),are proposed to accelerate healing while minimizing immobilization risks.This work redefines conservative fracture management paradigms,emphasizing in-novation without compromising efficacy.Overall,this assessment deepens our understanding of the conservative management of hook fractures and provides evidence-based insights for improved clinical decision-making.
基金supports of Basic Science Center Program for Multiphase Evolution in Hyper-gravity of the National Natural Science Foundation of China(No.51988101)National Natural Science Foundation of China(Nos.52109138 and 52122403)Young Elite Scientists Sponsorship Program by CAST(No.2023QNRC001).
文摘Hydraulic fracture growth is significantly influenced by the minimum horizontal principal stress gradient and the fracturing fluid pressure gradient.However,these gradients are often neglected in scaled physical modeling experiments due to difficulties in reproducing them.This study uses centrifugal hypergravity to simulate both gradients and investigate their effects on fracture propagation.Artificial mortar specimens(ϕ200 mm×400 mm)are fractured under 1g(normal gravity),50g,and 100g.Results show that compared to 1g,fractures under 50g and 100g exhibit increasingly uneven propagation,with higher g-values leading to greater asymmetry.To interpret this,a theoretical analysis based on fracture mechanics is conducted.When the fluid pressure gradient exceeds the stress gradient,a positive net gradient is generated,increasing net pressure at the lower fracture tip.This raises the stress intensity factor at the lower tip,promoting downward growth.As g increases,the disparity becomes more significant,resulting in greater fracture deviation.In conclusion,this study,for the first time,has verified and explained that the net gradient can change the propagation of hydraulic fractures,providing important guidance for wellbore placement under stress gradients.
文摘To compare the clinical efficacy of locking plate(LP)fixation and intramedullary nail(IMN)fixation for the treatment of post-traumatic nonunion of diaphyseal fractures of the femur and tibia.Methods:This single-center retrospective comparative study included 50 adult patients with aseptic nonunion of femoral or tibial diaphyseal fractures treated at our institution between January 2015 and January 2025.Patients underwent either locking-plate(LP)fixation(n=25)or intramedullary nailing(IMN)(n=25).The primary outcome was radiographic union at 12 months postoperatively.Secondary outcomes included time to union,operative time,intraoperative blood loss,length of hospital stay,incidence of complications(superficial/deep infection,implant failure,malunion),and 12-month functional status assessed by the Lower Extremity Functional Scale(LEFS).Statistical comparisons used Welch t tests for continuous variables and χ^(2) or Fisher exact tests for categorical variables.The protocol received institutional review board approval with waiver of informed consent.Results:Among 50 patients(LP=25;IMN=25),the 12-month union rate was 88.00%(22/25)in the LP group and 96.00%(24/25)in the IMN group(p=0.609).Time to union was shorter with IMN(6.20±1.83 vs 7.51±2.12 months;p=0.023).Operative time(110.52±25.23 vs 145.81±30.21 min;p<0.01)and intraoperative blood loss(250.41±80.64 vs 350.22±95.30 ml;p<0.01)favored IMN.Length of hospital stay was similar(6.24±1.83 vs 6.82±2.11 days;p=0.284).The incidence of superficial wound infection did not differ significantly(12.00%vs 4.00%;p=0.609).Twelve-month LEFS scores were comparable(65.44±10.21 vs 67.10±9.83;p=0.451).Conclusion:Both locking plate and intramedullary nail fixation are effective in the treatment of femoral and tibial nonunion,with high rates of union and good functional outcomes.Intramedullary nailing may be associated with a shorter time to union,reduced operative time and blood loss,and a lower risk of superficial wound infection compared to locking plate fixation.The choice of implant should be individualized based on fracture characteristics,patient factors,and surgeon preference.
基金Supported by the Science project of Health Commission of Hunan Province,No.20230844.
文摘Epiphyseal fracture is a significant etiology of limb deformity in children following fractures.However,unlike the rapid advancements in orthopedics,progress regarding the pathological changes,diagnosis,and treatment of epi-physeal fractures has been slow.This review provides an overview of the epide-miology and classification of epiphyseal fractures,as well as the post-fracture pathological changes occurring within the epiphysis and its surrounding areas.Furthermore,it reviews recent advancements in the treatment of epiphyseal fractures.By summarizing laboratory-to-clinical progress related to this type of fracture,this article aims to assist pediatric orthopedists in accurately recognizing,diagnosing,and treating such injuries.
基金the National Natural Science Foundation of China(Grant No.52309130)the Natural Science Foundation of Shandong Province(Grant No.ZR2022QD004).
文摘The mineralogy and texture of granite have been found to have a pronounced effect on its mechanical behavior.However,the precise manner in which the texture of granite affects the shear behavior of fractures remains enigmatic.In this study,fine-grained granite(FG)and coarse-grained granite(CG)were used to create tensile fractures with surface roughness(i.e.joint roughness coefficient(JRC))within the range of 5.48-8.34 and 12.68-16.5,respectively.The pre-fractured specimens were then subjected to direct shear tests under normal stresses of 1-30 MPa.The results reveal that shear strengths are smaller and stick-slip behaviors are more intense for FG fractures than for CG fractures,which is attributed to the different conditions of the shear surface constrained by the grain size.The smaller grain size in FG contributes to the smoother fracture surface and lower shear strength.The negative friction rate parameter a-b for both CG and FG fractures and the larger shear stiffness for FG than for CG fractures can account for the more intense stick-slip behaviors in FG fractures.The relative crack density for the post-shear CG fractures is greater than that of the FG fractures under the same normal stress,both of which decrease with the distance away from the shear surface following the power law.Moreover,the damage of CG fracture extends to a larger extent beneath the surface compared with the FG fracture.Our findings demonstrate that the grain size of the host rock exerts a significant influence on the fracture roughness,and thus should be incorporated into the assessment of fault slip behavior to better understand the role of mineralogy and texture in seismic activities.
文摘BACKGROUND Clavicle fractures are a common type of fracture that often occurs after high-energy trauma.The treatment methods for clavicle fractures remain controversial.Both locking compression and hook plates are recommended.CASE SUMMARY A 44-year-old male suffered an injury during skiing.Radiography revealed a right-sided distal clavicular fracture.The fracture was treated using a hook plate due to its small size.During the surgical procedure,Kirschner wires were used to drill holes in the acromion.The end of the hook plate was inserted into the hole rather than below the edge of the acromion.CONCLUSION One year later,imaging revealed complete healing of the fracture,and the hook plate was removed.The patient was satisfied with the course and treatment results.Additionally,a new classification system was proposed based on the degree of injury to the distal clavicle joint surface.The incidence of postoperative complications associated with the use of hook plates for clavicular fracture treatment is relatively high.Complications can be reduced by changing the hook plate placement.
基金funded by the National Natural Science Foundation of China(Grant Nos.52278398 and U23A0664).
文摘To evaluate the thermal behavior of tunnels,an equivalent thermal conductivity(ETC)model for the fractured rock masses surrounding tunnels was proposed,based on the series-parallel theory,which incorporates the heat transfer characteristics of the surrounding rock.A thermal probe test(TPT)was subsequently conducted at the Dajian Mountain Tunnel(China),and the heat transfer model of the thermal probe was developed and calibrated based on the TPT results.The ETCs of different test areas in the borehole were calculated based on the fracture parameters(dip direction,dip angle,opening,trace length),obtained via a digital borehole photography test.Finally,the new ETC model,the volumeaveraged model,and the non-fracture model were compared for accuracy in heat transfer calculation.The results demonstrate that(1)the error of heat transfer calculation error was reduced by 17.2%e69.2%using the new ETC model.(2)For the ETCs of different thermal response test areas,the minimum and maximum values were 2.15 W/(m K)and 3.7 W/(m K),respectively,with the fracture effect causing up to a 41.2%reduction in thermal conductivity.(3)For the ETC of the borehole,the ETC value was 2.53 W/(m K),with the fracture effect leading to a 31.6%reduction in thermal conductivity.The effect of fractures on the thermal conductivity of rock mass could not be ignored.This ETC model addresses the challenge of determining the ETC for the heterogeneous surrounding rock of tunnels and provides a more accurate representation of the in situ thermal behavior of tunnels.
基金supported by the National Natural Science Foundation of China(Grant No.52304003)the Natural Science Foundation of Sichuan Province(Grant No.2024NSFSC0961)the Postdoctoral Fellowship Program of CPSF(Grant No.GZB20230090).
文摘The glutenite reservoir is strongly heterogeneous due to the random distribution of gravels, making it challenging to perform hydraulic fracturing effectively. To solve this issue, it is essential to study interaction behavior between hydraulic fractures(HFs) and gravels. A coupled hydro-mechanical model is proposed for HF propagation in glutenite using a grain-based discrete element method. This paper first investigates the dynamic evolution of HFs in glutenite, then analyzes the influences of various factors such as horizontal stress difference(Δσ), minimum horizontal stress(σh), gravel content(Vg), gravel size(dg), and stiffness ratio of gravel to matrix(Rs) on HF propagation geometries. Results show that penetrating the gravel is the primary HF-gravel interaction behavior, which follows sequential and staggered initiation modes. Bypassing the gravel is the secondary behavior, which obeys the sequential initiation mode and occurs when the orientation of the gravel boundary is inclined to the maximum horizontal stress(σH). An offset along the gravel boundary is usually formed while penetrating gravels, and the offsets may cause fracture widths to decrease by 37.8%-84.4%. Even if stress dominates the direction of HF propagation, HFs still tend to deflect within gravels. The deviation angle from σH decreases with rising Δσand increases with the increase of dgand Rs. Additionally, intra-gravel shear HFs(IGS-HFs) are prone to be generated in coarse-grained glutenite under high Δσ, while more gravel-bypassing shear HFs(GBSHFs) tend to be created in argillaceous glutenite with high Rsthan in sandy glutenite with low Rs. The findings above prompt the emergence of a novel HF propagation pattern in glutenite, which helps to understand the real HF geometries and to provide theoretical guidance for treatments in the field.
