Introduction: Proximal femoral nail is a better choice of implant for the treatment of an unstable trochanteric fracture, however it is associated with screw migration and cutout because of greater trochanteric commin...Introduction: Proximal femoral nail is a better choice of implant for the treatment of an unstable trochanteric fracture, however it is associated with screw migration and cutout because of greater trochanteric comminution and coronal split. This study is to evaluate the results of Trochanteric Buttress Plate (TBP) combined with PFN in an unstable IT fractures for buttressing lateral wall and reinforcing fixation. Materials and Methods: We carried out a consecutive study of 32 patients of Unstable intertrochanteric fracture femur with lateral wall comminution. It was studied at Ashwini Sahakari Rugnalaya and Sanshodhan Kendra Solapur India and Government medical college Chandrapur India from April-2015 to December-2017 using innovative Trochanteric buttress plate along with PFN. Eighteen male and fourteen female in the age group of 55 to 80 years were included in the study. There were 26 cases of A3 and six cases of A2 were fixed by PFN combined with trochanteric buttress plate to augment the comminuted lateral wall. Results: The bone healing is observed in all the cases in the mean period of 12.6 weeks. Four patients developed complications, including lateral migration of neck screws (n = 2), superficial infection (n = 2). Patients were followed up for a mean of 10.6 months. At the end of follow-up the Salvati and Wilson hip function was 36 (out of 40) in 87.5% of patients [twenty eight patients]. The clinical, radiological and functional outcomes were found to be satisfactory. Conclusion: The stabilization of lateral trochanteric wall with trochanteric buttress plate restores anatomy, increases the stability of construct and prevents inherent complication of screw migration and cutout.展开更多
Radial nerve injuries in displaced extension-type supracondylar humeral fractures in children are well known. Entrapment in fracture of radial nerve is uncommon and rarely evocated in literature. We report two similar...Radial nerve injuries in displaced extension-type supracondylar humeral fractures in children are well known. Entrapment in fracture of radial nerve is uncommon and rarely evocated in literature. We report two similar cases in the mechanism of injury, the clinical findings and the treatment and propose therapeutic guidelines.展开更多
Complex trimalleolar ankle fractures are a major orthopaedic challenge,with an incidence of 4.22 per 10000 person-years in the United States and an annual cost of 3.4 billion dollars.This review synthesizes current ev...Complex trimalleolar ankle fractures are a major orthopaedic challenge,with an incidence of 4.22 per 10000 person-years in the United States and an annual cost of 3.4 billion dollars.This review synthesizes current evidence on diagnostic protocols and management strategies,highlighting optimal approaches and emerging trends.Initial care emphasizes soft tissue assessment,often guided by the Tscherne classification,and fracture classification systems.External fixation may be required in open injuries,while early open reduction and internal fixation within six days is linked to improved outcomes.Minimally invasive techniques for the lateral malleolus,including intramedullary nailing and locking plates,are effective,while medial malleolus fractures are commonly managed with screw fixation or tension-band wiring.Posterior malleolus fragments involving more than 25%of the articular surface usually warrant fixation.Alternatives to syndesmotic screws,such as cortical buttons or high-strength sutures,reduce the need for secondary procedures.Arthroscopic-assisted open reduction and internal fixation benefits younger,active patients by enabling concurrent management of intra-articular and ligamentous injuries.Postoperative care prioritizes early weight-bearing and validated functional scores.Despite advances,complications remain common,and further research is needed to refine surgical strategies and improve outcomes.展开更多
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 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
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 Postoperative delirium(POD)is a prevalent complication,particularly in elderly patients with hip fractures(HFs).It significantly affects recovery,length of hospital stay,healthcare costs,and long-term outco...BACKGROUND Postoperative delirium(POD)is a prevalent complication,particularly in elderly patients with hip fractures(HFs).It significantly affects recovery,length of hospital stay,healthcare costs,and long-term outcomes.Existing studies have investigated risk factors for POD,but most are limited by single-factor analyses or small sample sizes.This study systematically determines independent risk factors using large-scale data and machine learning techniques and develops a validated nomogram model to support early prediction and management of POD.AIM To investigate POD incidence in elderly patients with HF and the independent risk factors,according to which a nomogram prediction model was developed and validated.METHODS This retrospective study included elderly patients with HF who were surgically treated in Dongying People’sHospital from April 2018 to April 2022. The endpoint event includes POD. They were categorized into themodeling and validation cohorts in a 7:3 ratio by randomization. Both cohorts were further classified into thedelirium and normal (non-delirium) groups according to the presence or absence of the endpoint event. Theincidence of POD was calculated, and logistic multivariate analysis was conducted to determine the independentrisk factors. The calibration curve and the Hosmer-Lemeshow test as well as the net benefit threshold probabilityinterval by the decision curve were utilized to statistically validate the accuracy of the nomogram predictionmodel, developed according to each factor’s influence intensity.RESULTSThis study included 532 elderly patients with HF, with an overall POD incidence of 14.85%. The comparison ofbaseline data with perioperative indicators revealed statistical differences in age (P < 0.001), number of comorbidities(P = 0.042), American Society of Anesthesiologists grading (P = 0.004), preoperative red blood cell(RBC) count (P < 0.001), preoperative albumin (P < 0.001), preoperative hemoglobin (P < 0.001), preoperativeplatelet count (P < 0.001), intraoperative blood loss (P < 0.001), RBC transfusion of ≥ 2 units (P = 0.001), andpostoperative intensive care unit care (P < 0.001) between the delirium and non-delirium groups. The participantswere randomized to a training group (n = 372) and a validation group (n = 160). A score-risk nomogram predictionmodel was developed after screening key POD features using Lasso regression, support vector machine, and therandom forest method. The nomogram showed excellent discriminatory capacity with area under the curve of0.833 [95% confidence interval (CI) interval: 0.774-0.888] in the training group and 0.850 (95%CI: 0.718-0.982) in thevalidation group. Calibration curves demonstrated good agreement between predicted and actual probabilities,and decision curve analysis confirmed clinical net benefits within risk thresholds of 0%-30% and 0%-36%, respectively.The model has strong accuracy and clinical utility for predicting the risk of POD.CONCLUSIONThis study reveals cognitive impairment history, American Society of Anesthesiologists grade of > 2, RBCtransfusion of ≥ 2 units, postoperative intensive care unit care, and preoperative hemoglobin level as independentrisk factors for POD in elderly patients with HF. The developed nomogram model demonstrates excellent accuracyand stability in predicting the risk of POD, which is recommended to be applied in clinical practice to optimizepostoperative management and reduce delirium incidence.展开更多
Rock fractures or faults could be reactivated by the thermal stress generated during the decay process of the high-level radioactive waste in deep geological repositories(DGRs).Understanding thermoshearing behavior an...Rock fractures or faults could be reactivated by the thermal stress generated during the decay process of the high-level radioactive waste in deep geological repositories(DGRs).Understanding thermoshearing behavior and its influencing factors are important for the long-term performance assessment of DGRs.We designed multistage mechanical(M)shear tests and thermomechanical(TM)shear tests on three 100 mm-cubic granite specimens,each containing a single inclined sawcut fracture with distinct microroughness of 8-15μm.M test results have shown that the static friction coefficient of the granite fracture decreases in proportion to the increase in the logarithm of the loading rate within the range of 1-15 kPa/s.For the given heating and boundary conditions,thermal loading rate,i.e.,thermal stress increment with heating time,is measured to be around 1 kPa/s in the fractured granite.Thermoshearing can be well predicted by the linear Mohr-Coulomb failure envelope deduced from M shear tests employing a loading rate that is comparable with the thermal loading rate.The granite fractures exhibited two distinct slip patterns during the mechanical shearing,i.e.,stick-slip observed in the smooth fracture and stable sliding in the relatively rough surface.In contrast,the mechanical loading rate(1-15 kPa/s)investigated in this study appears to not influence the slip pattern.Unlike those in M shear tests,thermoshearing in both smooth and relatively rough fractures show stable sliding with a very slow peak velocity of around 0.002μm/s.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
Fractures are critical control factors in volcanic reservoirs.Thus,studies on the prediction and distribution patterns of volcanic fractures are crucial for oil and gas exploration and development.Although considerabl...Fractures are critical control factors in volcanic reservoirs.Thus,studies on the prediction and distribution patterns of volcanic fractures are crucial for oil and gas exploration and development.Although considerable research has been conducted on volcanic fractures,targeted research on the spatial distribution patterns of fracture development remains limited in the literature.Two eruption modes,subaqueous eruption and subaerial eruption,have been identified in the Chaganhua subsag of the Songliao Basin,where gas resources have been discovered.Studying the differences in volcanic fracture development is highly important for understanding the law of oil and gas enrichment in volcanic reservoirs.On the basis of thin sections,cores,electrical imaging logs,and other data obtained from boreholes of subaqueous volcanic eruptions in the Songnan fault depression,we describe the characteristics of drilled fractures in detail and use 3D seismic data to extract intrinsic coherence,ant bodies,and Fourier series to extend the azimuthal anisotropic P-wave reflection coefficient,thereby predicting the spatial distribution of fractures at different scales.Moreover,through statistical analysis of quantitative evaluation indicators,such as fracture density and fracture development rate in different drilling wells,combined with the spatial distribution patterns of the predicted fractures,we compared and analyzed the relationships between the distributions of fractures and volcanic institutions,lithology,and volcanic facies.Results indicate that fractures are more developed in volcanic edifices located closer to faults.Considerable differences in fracture development are observed among lithofacies of volcanic rocks.Near faults,effusion facies,explosive facies and external clastic pyroclastic sedimentary subfacies are favorable for fracture development.This research provides a reference for investigating volcanic rock fractures of the same origins worldwide.展开更多
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
According to World Health Organization,one in six people will be older than 60 by 2030.The rising life expectancy is anticipated to contribute to a subsequent increase of geriatric fractures worldwide.Osteosarcopenia,...According to World Health Organization,one in six people will be older than 60 by 2030.The rising life expectancy is anticipated to contribute to a subsequent increase of geriatric fractures worldwide.Osteosarcopenia,which is the coexistence of osteoporosis and sarcopenia,greatly affects older people.Recent studies have tried to identify the prevalence of osteosarcopenia in older populations as well as its correlation with fragility fractures such as hip fractures.The latter pose a major burden on both health loss and costs worldwide.Increasing amount of evidence suggests that osteosarcopenia in patients with hip fractures contributes to higher rates of mortality and complications.At the same time,research focuses on the molecular basis of the interplay between osteoporosis and sarcopenia by utilizing genomic or proteomic approaches.These promising studies could reveal potential preventive or diagnostic biomarkers to optimize the management of osteosarcopenia in hip fractures patients.The fact that bones and muscle can also function as endocrine organs further highlights the complex relationship between osteoporosis and sarcopenia,underscoring the need for a better understanding of the role of myokines and osteokines in osteosarcopenia.Finally,the impact of osteosarcopenia on pain management and rehabilitation after hip fracture surgery,requires further assessment.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
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
Stereoscopic particle image velocimetry technology was employed to investigate the planar three-dimensional velocity field and the process of proppant entry into branch fractures in a fracture configuration of“vertic...Stereoscopic particle image velocimetry technology was employed to investigate the planar three-dimensional velocity field and the process of proppant entry into branch fractures in a fracture configuration of“vertical main fracture-vertical branch fracture”intersecting at a 90°angle.This study analyzed the effects of pumping rate,fracturing fluid viscosity,proppant particle size,and fracture width on the transport behavior of proppant into branch fractures.Based on the deflection behavior of proppant,the main fractures can be divided into five regions:pre-entry transition,pre-entry stabilization,deflection entry at the fracture mouth,rear absorption entry,and movement away from the fracture mouth.Proppant primarily deflects into the branch fracture at the fracture mouth,with a small portion drawn in from the rear of the intersection.Increasing the pumping rate,reducing the proppant particle size,and widening the branch fracture are conducive to promoting proppant deflection into the branch.With increasing fracturing fluid viscosity,the ability of proppant to enter the branch fracture first improves and then declines,indicating that excessively high viscosity is unfavorable for proppant entry into the branch.During field operations,a high pumping rate and micro-to small-sized proppant can be used in the early stage to ensure effective placement in the branch fractures,followed by medium-to large-sized proppant to ensure adequate placement in the main fracture and enhance the overall conductivity of the fracture network.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 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
To accurately analyze proppant transport in rough intersecting fractures and elucidate the interaction mechanisms among liquid,particles,and rough walls,this study reconstructed a numerical model of fractures in inhom...To accurately analyze proppant transport in rough intersecting fractures and elucidate the interaction mechanisms among liquid,particles,and rough walls,this study reconstructed a numerical model of fractures in inhomogeneous reservoirs with varying brittleness index(BI).Various auto-correlation Gaussian rough fracture models were created using Matlab to assess roughness through the fractal dimension method.This research innovatively combined Boolean operations to establish three-dimensional rough fracture models,incorporating(Computational Fluid Dynamics)CFD-DEM(Discrete Element Method)with a bidirectional method for cosimulation.The proppant transport in fractures was categorized into three zones based on the difference in the turbulent kinetic energy.Artificially induced fracture roughness increases fluid retention and turbulence,causing plugging effects and limiting proppant flow into branch fractures.Additionally,compared with the superior deposition and significant support effects of the spherical proppant,the low-sphericity proppant traveled farther under fracturing fluid,inducing more pronounced plugging near curved fracture intersections;the variation in fracture intersection angles primarily impacted the wall shear stress within the flow field,indicating smaller angles led to higher shear energy at the intersection.Compared with the intersection angle of 30°,the height and area deposited in the 90 branch fracture increased by 52.25%and 65.33%,respectively:notably,injecting proppant from smaller to larger particles(S:M:L)and a low velocity effectively ensured fracture conductivity near the wellbore at joint roughness coefficient(JRC)≥46 while achieving satis-factory placement in the branch fracture,making it a recommended approach.展开更多
Shale reservoirs are characterized by numerous geological discontinuities,such as bedding planes,and exhibit pronounced heterogeneity across rock layers separated by these planes.Bedding planes often possess distinct ...Shale reservoirs are characterized by numerous geological discontinuities,such as bedding planes,and exhibit pronounced heterogeneity across rock layers separated by these planes.Bedding planes often possess distinct mechanical properties compared to the surrounding rock matrix,particularly in terms of damage and fracture behavior.Consequently,vertical propagation of hydraulic fractures is influenced by both bedding planes and the heterogeneity.In this study,a numerical investigation into the height growth of hydraulic fractures was conducted using the finite element method,incorporating zero-thickness cohesive elements.The analysis explored the effects of bedding planes,toughness contrasts between layers,and variations in in-situ stress across different strata.The results reveal that hydraulic fractures are more likely to propagate along bedding planes instead of traversing them and extending vertically into barrier layers when(1)bedding strength is low,(2)stress contrast between layers is high,and(3)toughness contrast is significant.Furthermore,for a given bedding strength,increased stress contrast or higher toughness contrast between layers elevate hydraulic fracture extension pressure.When a substantial stress difference exists between layers(Lc 0.4),hydraulic=fractures preferentially propagate along bedding planes.Conversely,as bedding strength increases,the propagation distance along bedding planes decreases,accompanied by an amplified horizontal compressive stress field.Notably,when the stress difference is sufficiently small(SD a phenomenon termed“stress rolling”emerges,wherein<-0.2),hydraulic fractures deviate from vertical growth and instead extend along a near-horizontal trajectory.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
文摘Introduction: Proximal femoral nail is a better choice of implant for the treatment of an unstable trochanteric fracture, however it is associated with screw migration and cutout because of greater trochanteric comminution and coronal split. This study is to evaluate the results of Trochanteric Buttress Plate (TBP) combined with PFN in an unstable IT fractures for buttressing lateral wall and reinforcing fixation. Materials and Methods: We carried out a consecutive study of 32 patients of Unstable intertrochanteric fracture femur with lateral wall comminution. It was studied at Ashwini Sahakari Rugnalaya and Sanshodhan Kendra Solapur India and Government medical college Chandrapur India from April-2015 to December-2017 using innovative Trochanteric buttress plate along with PFN. Eighteen male and fourteen female in the age group of 55 to 80 years were included in the study. There were 26 cases of A3 and six cases of A2 were fixed by PFN combined with trochanteric buttress plate to augment the comminuted lateral wall. Results: The bone healing is observed in all the cases in the mean period of 12.6 weeks. Four patients developed complications, including lateral migration of neck screws (n = 2), superficial infection (n = 2). Patients were followed up for a mean of 10.6 months. At the end of follow-up the Salvati and Wilson hip function was 36 (out of 40) in 87.5% of patients [twenty eight patients]. The clinical, radiological and functional outcomes were found to be satisfactory. Conclusion: The stabilization of lateral trochanteric wall with trochanteric buttress plate restores anatomy, increases the stability of construct and prevents inherent complication of screw migration and cutout.
文摘Radial nerve injuries in displaced extension-type supracondylar humeral fractures in children are well known. Entrapment in fracture of radial nerve is uncommon and rarely evocated in literature. We report two similar cases in the mechanism of injury, the clinical findings and the treatment and propose therapeutic guidelines.
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 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financially supported by,the Fundamental Research Funds for the Central Universities(Grant No.2023QN1064)the China Postdoctoral Science Foundation(Grant No.2023M733772)Jiangsu Funding Program for Excellent Postdoctoral Talent(Grant No.2023ZB847)。
文摘Prepulse combined hydraulic fracturing facilitates the development of fracture networks by integrating prepulse hydraulic loading with conventional hydraulic fracturing.The formation mechanisms of fracture networks between hydraulic and pre-existing fractures under different prepulse loading parameters remain unclear.This research investigates the impact of prepulse loading parameters,including the prepulse loading number ratio(C),prepulse loading stress ratio(S),and prepulse loading frequency(f),on the formation of fracture networks between hydraulic and pre-existing fractures,using both experimental and numerical methods.The results suggest that low prepulse loading stress ratios and high prepulse loading number ratios are advantageous loading modes.Multiple hydraulic fractures are generated in the specimen under the advantageous loading modes,facilitating the development of a complex fracture network.Fatigue damage occurs in the specimen at the prepulse loading stage.The high water pressure at the secondary conventional hydraulic fracturing promotes the growth of hydraulic fractures along the damage zones.This allows the hydraulic fractures to propagate deeply and interact with pre-existing fractures.Under advantageous loading conditions,multiple hydraulic fractures can extend to pre-existing fractures,and these hydraulic fractures penetrate or propagate along pre-existing fractures.Especially when the approach angle is large,the damage range in the specimen during the prepulse loading stage increases,resulting in the formation of more hydraulic fractures.
基金Supported by Wang Zhengguo Foundation for Traumatic Medicine“Sequential Medical Research Special Foundation”,No 2024-XGM05.
文摘BACKGROUND Postoperative delirium(POD)is a prevalent complication,particularly in elderly patients with hip fractures(HFs).It significantly affects recovery,length of hospital stay,healthcare costs,and long-term outcomes.Existing studies have investigated risk factors for POD,but most are limited by single-factor analyses or small sample sizes.This study systematically determines independent risk factors using large-scale data and machine learning techniques and develops a validated nomogram model to support early prediction and management of POD.AIM To investigate POD incidence in elderly patients with HF and the independent risk factors,according to which a nomogram prediction model was developed and validated.METHODS This retrospective study included elderly patients with HF who were surgically treated in Dongying People’sHospital from April 2018 to April 2022. The endpoint event includes POD. They were categorized into themodeling and validation cohorts in a 7:3 ratio by randomization. Both cohorts were further classified into thedelirium and normal (non-delirium) groups according to the presence or absence of the endpoint event. Theincidence of POD was calculated, and logistic multivariate analysis was conducted to determine the independentrisk factors. The calibration curve and the Hosmer-Lemeshow test as well as the net benefit threshold probabilityinterval by the decision curve were utilized to statistically validate the accuracy of the nomogram predictionmodel, developed according to each factor’s influence intensity.RESULTSThis study included 532 elderly patients with HF, with an overall POD incidence of 14.85%. The comparison ofbaseline data with perioperative indicators revealed statistical differences in age (P < 0.001), number of comorbidities(P = 0.042), American Society of Anesthesiologists grading (P = 0.004), preoperative red blood cell(RBC) count (P < 0.001), preoperative albumin (P < 0.001), preoperative hemoglobin (P < 0.001), preoperativeplatelet count (P < 0.001), intraoperative blood loss (P < 0.001), RBC transfusion of ≥ 2 units (P = 0.001), andpostoperative intensive care unit care (P < 0.001) between the delirium and non-delirium groups. The participantswere randomized to a training group (n = 372) and a validation group (n = 160). A score-risk nomogram predictionmodel was developed after screening key POD features using Lasso regression, support vector machine, and therandom forest method. The nomogram showed excellent discriminatory capacity with area under the curve of0.833 [95% confidence interval (CI) interval: 0.774-0.888] in the training group and 0.850 (95%CI: 0.718-0.982) in thevalidation group. Calibration curves demonstrated good agreement between predicted and actual probabilities,and decision curve analysis confirmed clinical net benefits within risk thresholds of 0%-30% and 0%-36%, respectively.The model has strong accuracy and clinical utility for predicting the risk of POD.CONCLUSIONThis study reveals cognitive impairment history, American Society of Anesthesiologists grade of > 2, RBCtransfusion of ≥ 2 units, postoperative intensive care unit care, and preoperative hemoglobin level as independentrisk factors for POD in elderly patients with HF. The developed nomogram model demonstrates excellent accuracyand stability in predicting the risk of POD, which is recommended to be applied in clinical practice to optimizepostoperative management and reduce delirium incidence.
基金supported by the International Collaborative Research Program(fundamental research,2021-2023)funded by Korea Institute of Civil Engineering and Building Technology(KICT).
文摘Rock fractures or faults could be reactivated by the thermal stress generated during the decay process of the high-level radioactive waste in deep geological repositories(DGRs).Understanding thermoshearing behavior and its influencing factors are important for the long-term performance assessment of DGRs.We designed multistage mechanical(M)shear tests and thermomechanical(TM)shear tests on three 100 mm-cubic granite specimens,each containing a single inclined sawcut fracture with distinct microroughness of 8-15μm.M test results have shown that the static friction coefficient of the granite fracture decreases in proportion to the increase in the logarithm of the loading rate within the range of 1-15 kPa/s.For the given heating and boundary conditions,thermal loading rate,i.e.,thermal stress increment with heating time,is measured to be around 1 kPa/s in the fractured granite.Thermoshearing can be well predicted by the linear Mohr-Coulomb failure envelope deduced from M shear tests employing a loading rate that is comparable with the thermal loading rate.The granite fractures exhibited two distinct slip patterns during the mechanical shearing,i.e.,stick-slip observed in the smooth fracture and stable sliding in the relatively rough surface.In contrast,the mechanical loading rate(1-15 kPa/s)investigated in this study appears to not influence the slip pattern.Unlike those in M shear tests,thermoshearing in both smooth and relatively rough fractures show stable sliding with a very slow peak velocity of around 0.002μm/s.
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.
基金supported by General Projects of the Natural Science Foundation of China(41972313)major projects of the Natural Science Foundation of China(41790453)。
文摘Fractures are critical control factors in volcanic reservoirs.Thus,studies on the prediction and distribution patterns of volcanic fractures are crucial for oil and gas exploration and development.Although considerable research has been conducted on volcanic fractures,targeted research on the spatial distribution patterns of fracture development remains limited in the literature.Two eruption modes,subaqueous eruption and subaerial eruption,have been identified in the Chaganhua subsag of the Songliao Basin,where gas resources have been discovered.Studying the differences in volcanic fracture development is highly important for understanding the law of oil and gas enrichment in volcanic reservoirs.On the basis of thin sections,cores,electrical imaging logs,and other data obtained from boreholes of subaqueous volcanic eruptions in the Songnan fault depression,we describe the characteristics of drilled fractures in detail and use 3D seismic data to extract intrinsic coherence,ant bodies,and Fourier series to extend the azimuthal anisotropic P-wave reflection coefficient,thereby predicting the spatial distribution of fractures at different scales.Moreover,through statistical analysis of quantitative evaluation indicators,such as fracture density and fracture development rate in different drilling wells,combined with the spatial distribution patterns of the predicted fractures,we compared and analyzed the relationships between the distributions of fractures and volcanic institutions,lithology,and volcanic facies.Results indicate that fractures are more developed in volcanic edifices located closer to faults.Considerable differences in fracture development are observed among lithofacies of volcanic rocks.Near faults,effusion facies,explosive facies and external clastic pyroclastic sedimentary subfacies are favorable for fracture development.This research provides a reference for investigating volcanic rock fractures of the same origins worldwide.
基金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.
文摘According to World Health Organization,one in six people will be older than 60 by 2030.The rising life expectancy is anticipated to contribute to a subsequent increase of geriatric fractures worldwide.Osteosarcopenia,which is the coexistence of osteoporosis and sarcopenia,greatly affects older people.Recent studies have tried to identify the prevalence of osteosarcopenia in older populations as well as its correlation with fragility fractures such as hip fractures.The latter pose a major burden on both health loss and costs worldwide.Increasing amount of evidence suggests that osteosarcopenia in patients with hip fractures contributes to higher rates of mortality and complications.At the same time,research focuses on the molecular basis of the interplay between osteoporosis and sarcopenia by utilizing genomic or proteomic approaches.These promising studies could reveal potential preventive or diagnostic biomarkers to optimize the management of osteosarcopenia in hip fractures patients.The fact that bones and muscle can also function as endocrine organs further highlights the complex relationship between osteoporosis and sarcopenia,underscoring the need for a better understanding of the role of myokines and osteokines in osteosarcopenia.Finally,the impact of osteosarcopenia on pain management and rehabilitation after hip fracture surgery,requires further assessment.
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.
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 Joint Funds of the National Natural Science Foundation of China(U23B6004).
文摘Stereoscopic particle image velocimetry technology was employed to investigate the planar three-dimensional velocity field and the process of proppant entry into branch fractures in a fracture configuration of“vertical main fracture-vertical branch fracture”intersecting at a 90°angle.This study analyzed the effects of pumping rate,fracturing fluid viscosity,proppant particle size,and fracture width on the transport behavior of proppant into branch fractures.Based on the deflection behavior of proppant,the main fractures can be divided into five regions:pre-entry transition,pre-entry stabilization,deflection entry at the fracture mouth,rear absorption entry,and movement away from the fracture mouth.Proppant primarily deflects into the branch fracture at the fracture mouth,with a small portion drawn in from the rear of the intersection.Increasing the pumping rate,reducing the proppant particle size,and widening the branch fracture are conducive to promoting proppant deflection into the branch.With increasing fracturing fluid viscosity,the ability of proppant to enter the branch fracture first improves and then declines,indicating that excessively high viscosity is unfavorable for proppant entry into the branch.During field operations,a high pumping rate and micro-to small-sized proppant can be used in the early stage to ensure effective placement in the branch fractures,followed by medium-to large-sized proppant to ensure adequate placement in the main fracture and enhance the overall conductivity of the fracture network.
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 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To accurately analyze proppant transport in rough intersecting fractures and elucidate the interaction mechanisms among liquid,particles,and rough walls,this study reconstructed a numerical model of fractures in inhomogeneous reservoirs with varying brittleness index(BI).Various auto-correlation Gaussian rough fracture models were created using Matlab to assess roughness through the fractal dimension method.This research innovatively combined Boolean operations to establish three-dimensional rough fracture models,incorporating(Computational Fluid Dynamics)CFD-DEM(Discrete Element Method)with a bidirectional method for cosimulation.The proppant transport in fractures was categorized into three zones based on the difference in the turbulent kinetic energy.Artificially induced fracture roughness increases fluid retention and turbulence,causing plugging effects and limiting proppant flow into branch fractures.Additionally,compared with the superior deposition and significant support effects of the spherical proppant,the low-sphericity proppant traveled farther under fracturing fluid,inducing more pronounced plugging near curved fracture intersections;the variation in fracture intersection angles primarily impacted the wall shear stress within the flow field,indicating smaller angles led to higher shear energy at the intersection.Compared with the intersection angle of 30°,the height and area deposited in the 90 branch fracture increased by 52.25%and 65.33%,respectively:notably,injecting proppant from smaller to larger particles(S:M:L)and a low velocity effectively ensured fracture conductivity near the wellbore at joint roughness coefficient(JRC)≥46 while achieving satis-factory placement in the branch fracture,making it a recommended approach.
基金the National Natural Science Foundation of China(No.52204052)the NationalNatural Science Foundation of China(No.U23B20156)the Sichuan Science and Technology Program(No.2023NSFSC0933).
文摘Shale reservoirs are characterized by numerous geological discontinuities,such as bedding planes,and exhibit pronounced heterogeneity across rock layers separated by these planes.Bedding planes often possess distinct mechanical properties compared to the surrounding rock matrix,particularly in terms of damage and fracture behavior.Consequently,vertical propagation of hydraulic fractures is influenced by both bedding planes and the heterogeneity.In this study,a numerical investigation into the height growth of hydraulic fractures was conducted using the finite element method,incorporating zero-thickness cohesive elements.The analysis explored the effects of bedding planes,toughness contrasts between layers,and variations in in-situ stress across different strata.The results reveal that hydraulic fractures are more likely to propagate along bedding planes instead of traversing them and extending vertically into barrier layers when(1)bedding strength is low,(2)stress contrast between layers is high,and(3)toughness contrast is significant.Furthermore,for a given bedding strength,increased stress contrast or higher toughness contrast between layers elevate hydraulic fracture extension pressure.When a substantial stress difference exists between layers(Lc 0.4),hydraulic=fractures preferentially propagate along bedding planes.Conversely,as bedding strength increases,the propagation distance along bedding planes decreases,accompanied by an amplified horizontal compressive stress field.Notably,when the stress difference is sufficiently small(SD a phenomenon termed“stress rolling”emerges,wherein<-0.2),hydraulic fractures deviate from vertical growth and instead extend along a near-horizontal trajectory.
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.
