Search results for: femur fractures

Authors: Khaled Harrar, Rachid Jennane

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The purpose of this study is the discrimination of 28 postmenopausal with osteoporotic femoral fractures from an age-matched control group of 28 women using texture analysis based on fractals. Two pre-processing approaches are applied on radiographic images; these techniques are compared to highlight the choice of the pre-processing method. Furthermore, the values of the fractal dimension are compared to those of the fractal signature in terms of the classification of the two populations. In a second analysis, the BMD measure at proximal femur was compared to the fractal analysis, the latter, which is a non-invasive technique, allowed a better discrimination; the results confirm that the fractal analysis of texture on calcaneus radiographs is able to discriminate osteoporotic patients with femoral fracture from controls. This discrimination was efficient compared to that obtained by BMD alone. It was also present in comparing subgroups with overlapping values of BMD.

Keywords: osteoporosis, fractal dimension, fractal signature, bone mineral density

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Authors: Eyal Rosen

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This study is aimed to report a possible effect of the presence of dental implants on the development of crown or root fractures in adjacent natural teeth. A series of 26 cases of teeth diagnosed with crown or root fractures following the placement of adjacent dental implants is presented. In addition, a comprehensive systematic review of the literature was performed to detect other studies that evaluated this possible complication. The case series analysis revealed that all crown-fractured teeth were non-endodontically treated teeth (n=18), and all root fractured teeth were endodontically treated teeth (n=8). The time from implant loading to the diagnosis of a fracture in an adjacent tooth was longer than 1 year in 78% of cases. The majority of crown or root fractures occurred in female patients, over 50 years of age, with an average age of 59 in the crown fractures group, and 54 in the root fractures group. Most of the patients received 2 or more implants. Nine (50%) of the teeth with crown fracture were molars, 7 (39%) were mandibular premolars, and 2 (11%) were incisor teeth. The majority of teeth with root fracture were premolar or mandibular molar teeth (6 (75%)). The systematic review of the literature did not reveal additional studies that reported on this possible complication. To the best of the author’s knowledge this case series, although limited in its extent, is the first clinical report of a possible serious complication of implants, associated fractures in adjacent endodontically and non-endodontically treated natural teeth. The most common patient profile found in this series was a woman over 50 years of age, having a fractured premolar tooth, which was diagnosed more than 1 year after reconstruction that was based on multiple adjacent implants. Additional clinical studies are required in order to shed light on this potential serious complication.

Keywords: complications, dental implants, endodontics, fractured teeth

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Authors: S. Anwar Sathik, K. Manoj Deepak, K. Venkatachalam

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Our study is a prospective study on the use of bio absorbable pins for the treatment of osteochondral fractures after patellar dislocation.22 patients who presented with osteochondral fractures were treated in our institution. They were followed for a minimum of 12 months by regular radiological evaluation. Of the 22 patients, 2 had fragments that detached from the fracture site which was treated arthroscopically. All the patients underwent open reduction and fixation of the pins using bio absorbable crews. They were immobilized in the cast for a minimum of 6 weeks after which mobilization was started according to our protocol. Fracture consolidation was found to occur in 20 of the 22 patients. Thus, Bio absorbable screws can be used as a reliable method of fixation of the osteochondral fragments.

Keywords: osteochondral fracture, bio absorbable pins, patella dislocation, physiotherapy

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Authors: Guijie Sang, Geo Davis, Momchil Terziev

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Geological CO2 storage has been regarded as a promising strategy to mitigate the emission of greenhouse gas generated from traditional power stations and energy-intensive industry. Caprocks with very low permeability and ultra-fine pores create viscous and capillary barriers to guarantee CO2 sealing efficiency. However, caprock fractures, either naturally existing or artificially induced due to injection, could provide preferential paths for CO₂ escaping. Seeking an efficient technique to seal and strengthen caprock fractures is crucial. We apply microbial-induced-calcite-precipitation (MICP) technique for sealing and strengthening caprock fractures in the laboratory scale. The MICP bio-grouting technique has several advantages over conventional cement grouting methods, including its low viscosity, micron-size microbes (accessible to fine apertures), and low carbon footprint, among others. Different injection strategies are tested to achieve relatively homogenous calcite precipitation along the fractures, which is monitored dynamically based on laser ultrasonic technique. The MICP process in caprock fractures, which integrates the coupled flow and bio-chemical precipitation, is also modeled and validated through the experiment. The study could provide an effective bio-mediated grouting strategy for caprock sealing and thus ensuring a long-term safe geological CO2 storage.

Keywords: caprock sealing, geological CO2 storage, grouting strategy, microbial induced calcite precipitation

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Authors: P. Panwalkar, K. Veravalli, R. Gwynn, M. Tofighi, R. Clement, A. Mofidi

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When operating on tibial plateau fracture especially medial tibial plateau, it has regularly been said “where do I put my thumb to reduce the fracture”. This refers to the ideal placement of the buttress device to hold the fracture till union. The aim of this study was to see if one can identify this sweet spot using a CT scan. Methods: Forty-five tibial plateau fractures with medial plateau involvement were identified and included in the study. The preoperative CT scans were analysed and the medial plateau involvement pattern was classified based on modified radiological classification by Yukata et-al of stress fracture of medial tibial plateau. The involvement of part of plateau was compared with position of buttress plate position which was classified as medial posteromedial or both. Presence and position of the buttress was compared with ability to achieve and hold the reduction of the fracture till union. Results: Thirteen fractures were type-1 fracture, 19 fractures were type-2 fracture and 13 fractures were type-3 fracture. Sixteen fractures were buttressed correctly according to the potential deformity and twenty-six fractures were not buttressed and three fractures were partly buttressed correctly. No fracture was over butressed! When the fracture was buttressed correctly the rate of the malunion was 0%. When fracture was partly buttressed 33% were anatomically united and 66% were united in the plane of buttress. When buttress was not used, 14 were malunited, one malunited in one of the two planes of deformity and eleven anatomically healed (of which 9 were non displaced!). Buttressing resulted in statistically significant lower mal-union rate (x2=7.8, p=0.0052). Conclusion: The classification based on involvement of medial condyle can identify the placement of buttress plate in the tibial plateau. The correct placement of the buttress plate results in predictably satisfactory union. There may be a correlation between injury shape of the tibial plateau and the fracture type.

Keywords: knee, tibial plateau, trauma, CT scan, surgery

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Authors: Hong Je Kang, Young Chae Choi, Jin Sung Park, Isac Kim

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Purpose: Osteoporotic fractures are an important among postmenopausal women. When osteoporotic distal radial fractures occur, osteoporosis must be treated to prevent the hip and spine fractures. Intravenous injection of Zoledronic acid is expected to improve preventing osteoporotic fractures. Many articles reported the effect of intravenous Zoledronic acid to BMD of the hip and spine fracture or non-fracture patients with low BMD. However, that with distal radial fractures has rarely been reported. Therefore, the authors decided to study the effect of Zoledronic acid in BMD score, bone union, and bone turnover markers in the patients who underwent volar plating due to osteoporotic distal radial fractures. Materials: From April 2018 to May 2022, postmenopausal women aged 55 years or older who had osteoporotic distal radial fractures and who underwent surgical treatment using volar plate fixation were included. Zoledronic acid (5mg) was injected intravenously between 3 and 5 days after surgery. BMD scores after 1 year of operation were compared with the initial scores. Bone turnover markers were measured before surgery, after 3 months, and after 1 year. Radiological follow-up was performed every 2 weeks until the bone union and at 1 year postoperatively. Clinical outcome indicators were measured one year after surgery, and the occurrence of side effects was observed. Result: Total of 23 patients were included, with a lumbar BMD T score of -2.89±0.2 before surgery to -2.27±0.3 one year after surgery (p=0.012) and a femoral neck BMD T score of -2.45±0.3 before surgery to -2.36±0.3 (p=0.041) after one year, and all were statistically significant. Measured as bone resorption markers, serum CTX-1 was 337.43±10.4 pg/mL before surgery, 160.86±8.7 pg/mL (p=0.022) after three months, and 250.12±12.7 pg/mL (p=0.031) after one year. Urinary NTX-1 was 39.24±2.2 ng/mL before surgery, 24.46±1.2 ng/mL (p=0.014) after three months and 30.35±1.6 ng/mL (p=0.042) after one year. Measured as bone formation markers, serum osteocalcin was 13.04±1.1 ng/mL before surgery, 8.84±0.7 ng/mL (p=0.037) after 3 months and 11.1±0.4 ng/mL (p=0.026) after one year. Serum bone-specific ALP was 11.24±0.9 IU/L before surgery, 8.25±0.9 IU/L (p=0.036) after three months, and 10.2±0.9 IU/L (p=0.027) after one year. All were statistically significant. All cases showed bone union within an average of 6.91±0.3 weeks without any signs of failure. Complications were found in 5 out of 23 cases (21.7%), such as headache, nausea, muscle pain, and fever. Conclusion: When Zoledronic acid was used, BMD was improved in both the spine and femoral neck. This may reduce the likelihood and subsequent morbidity of additional osteoporotic fractures. This study is meaningful in that there was no difference in the duration of bone union and radiological characteristics in patients with distal radial fractures administrated with intravenous BP early after the fractures, and improvement in BMD and bone turnover indicators was measured.

Keywords: zeoldreonic acid, BMD, osteoporosis, distal radius

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Authors: Mauricio Plaza, Willian Aperador

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Hip disarticulation is an amputation through the hip joint capsule, removing the entire lower extremity, with a closure of the remaining musculature over the exposed acetabulum. Tumors of the distal and proximal femur were treated by total femur resection; a hip disarticulation sometimes is a performance for massive trauma with crush injuries to the lower extremity. This article discusses the design a system for rehabilitation of a patient with bilateral hip disarticulations. The prosthetics designed allowed the patient to do natural gait suspended between parallel articulate crutches with the body weight support between the crutches. The care of this patient was a challenge due to bilateral amputations at such a high level and the special needs of a patient mobility.

Keywords: amputation, prosthesis, mobility, hemipelvectomy

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Authors: S. alireza Mirghasemi, Shervin Rashidinia, Mohammadsaleh Sadeghi, Mohsen Talebizadeh, Narges Rahimi Gabaran, S. Shahin Eftekhari, Sara Shahmoradi

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Purpose: There are various pin-in-plaster methods for treating distal radius fractures. This study is meant to introduce a modified technique of pin-in-plaster. Materials and methods: Fifty-four patients with distal radius fractures were followed up for one year. Patients were excluded if they had type B fractures according to AO classification, multiple injuries or pathological fractures, and were treated more than 7 days after injury. Range of motion and functional results were evaluated. Radiographic parameters including radial inclination, tilt, and height, were measured preoperatively and postoperatively. Results: The average radial tilt was 10.6° and radial height was 10.2 mm at the sixth month postoperatively. Three cases of pin tract infection were recorded, who were treated totally with oral antibiotics. There was no case of pin loosening. Of total 73 patients underwent surgery, three cases of radial nerve irritation were recorded at the time of cast removal. All of them resolved at the 6th month follow up. No median nerve compression and carpal tunnel syndrome have found. We also had no case of tendon injury. Conclusion: Our modified technique is effective to restore anatomic congruity and maintain reduction.

Keywords: distal radius fracture, percutaneous pinning, pin-in-plaster, modified method of pin-in-plaster, operative treatment

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Authors: Krishna Prasad Regmi, Jun-Bo Tu, Cheng-Qun Hou, Li-Feng Li

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Maxillofacial trauma in a pediatric group of patients is particularly challenging, as these patients have significant differences from adults as far as the facial skeleton is concerned. Mandibular condylar fractures are common presentations to hospitals across the globe and remain the most important cause of temporomandibular joint (TMJ) ankylosis. The etiology and epidemiology of pediatric trauma involving the diacapitular condylar fractures (DFs) have been reported in a large series of patients. Nevertheless, little is known about treatment protocols for DFs in children. Accordingly, the treatment modalities for the management of pediatric fractures also differ. We suggest following the PDA and intracapsular ABC classification of condylar fracture to increase the overall postoperative satisfaction level that bypasses the change of subjective feelings of patients’ from preoperative to the postoperative condition. At the same time, use of 3-D technology and surgical navigation may also increase treatment accuracy.

Keywords: maxillofacial trauma, diacapitular fracture, condylar fracture, PDA classification

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Authors: Srikanta Tagore Sarkar, Prasanta Kumar Mandal, Dibakar Roy

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The association of a capitate fracture with a scaphoid fracture has been termed as the naviculocapitate syndrome. The existence of some nondisplaced fractures of scaphoid and capitate with or without the fracture of lunate or radius suggests that there is a spectrum of these injuries, and this confuses the terminology. With our case; we report an unusual variety of this naviculocapitate syndrome with distal radial Colles fracture in addition to the nondisplaced fractures of the scaphoid, capitate and the dorsal lip of radial fracture. When we looked at the literature there is no another Colles fracture reported together with undisplaced scapho-capitate syndrome. The coronal and sagittal images that obtained from the MDCT (Multidetector computed tomography) is useful and effective imaging modality to diagnose complex wrist fractures with more details that are not detected in X-rays.

Keywords: scaphoid, capitate, Colles’ fracture, syndrome, MDCT, unusual

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Authors: Fabiha Tanzeem

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BACKGROUND: Osteoporosis is a skeletal disease that is associated with a reduction in bone mass and microstructures of the bone and deterioration of bone tissue. Fragility fracture due to osteoporosis is the most significant complication of osteoporosis. The increasing prevalence of fragility fractures presents a growing burden on the global economy. There is a rapidly evolving need to improve awareness of the costs associated with these types of fractures and to review current policies and practices for the prevention and management of the disease. This systematic review will identify and describe the direct and indirect costs associated with osteoporotic fragility fractures from a global perspective from the included studies. The review will also find out whether the costs required for the treatment of fragility fractures due to osteoporosis impose an economic burden on the global healthcare system. METHODS: Four major databases were systematically searched for direct and indirect costs of osteoporotic fragility fracture studies in the English Language. PubMed, Cochrane Library, Embase and Google Scholar were searched for suitable articles published between 1990 and July 2020. RESULTS: The original search yielded 1166 papers; from these, 27 articles were selected for this review according to the inclusion and exclusion criteria. In the 27 studies, the highest direct costs were associated with the treatment of pelvic fractures, with the majority of the expenditure due to hospitalization and surgical treatments. It is also observed that most of the articles are from developed countries. CONCLUSION: This review indicates the significance of the economic burden of osteoporosis globally, although more research needs to be done in developing countries. In the treatment of fragility fractures, direct costs were the main reported expenditure in this review. The healthcare costs incurred globally can be significantly reduced by implementing measures to effectively prevent the disease. Raising awareness in children and adults by improving the quality of the information available and standardising policies and planning of services requires further research.

Keywords: systematic review, osteoporosis, cost of illness

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Authors: Isabel Moscol, Carlos J. Díaz, Ciro Rodríguez

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Hip replacement becomes necessary when a person suffers severe pain or considerable functional limitations and the best option to enhance their quality of life is through the replacement of the damaged joint. One of the main components in femoral prostheses is the stem which distributes the loads from the joint to the proximal femur. To preserve more bone stock and avoid weakening of the diaphysis, a short starting stem was selected, generated from the intramedullary morphology of the patient's femur. It ensures the implantability of the design and leads to geometric delimitation for personalized optimization with machine learning (ML) and metaheuristic algorithms. The present study attempts to design a cementless short stem to make the strain deviation before and after implantation close to zero, promoting its fixation and durability. Regression models developed to estimate the percentage change of maximum principal stresses were used as objective optimization functions by the metaheuristic algorithm. The latter evaluated different geometries of the short stem with the modification of certain parameters in oblique sections from the osteotomy plane. The optimized geometry reached a global stress shielding (SS) of 18.37% with a determination factor (R²) of 0.667. The predicted results favour implantability integration in the short stem optimization to effectively reduce SS in the proximal femur.

Keywords: machine learning techniques, metaheuristic algorithms, short-stem design, stress shielding, hip replacement

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Authors: Vrinda Hari Ankolekar, Anne D. Souza, Mamatha Hosapatna

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Introduction: Precise anatomical assessment of femoral neck anteversion (FNA) and the neck shaft angles (NSA) would be essential in diagnosing the pathological conditions involving hip joint and its ligaments. FNA of greater than 20 degrees is considered excessive femoral anteversion, whereas a torsion angle of fewer than 10 degrees is considered femoral retroversion. Excessive femoral torsion is not uncommon and has been associated with certain neurologic and orthopedic conditions. The enlargement and maturation of the hip joint increases at the 20th week of gestation and the NSA ranges from 135- 140◦ at birth. Material and methods: 48 femurs were tagged according to the GA and two photographs for each femur were taken using Nikon digital camera. Each femur was kept on a horizontal hard desk and end on an image of the upper end was taken for the estimation of FNA and a photograph in a perpendicular plane was taken to calculate the NSA. The images were transferred to the computer and were stored in TIFF format. Microsoft Paint software was used to mark the points and Image J software was used to calculate the angles digitally. 1. Calculation of FNA: The midpoint of the femoral head and the neck were marked and a line was drawn joining these two points. The angle made by this line with the horizontal plane was measured as FNA. 2. Calculation of NSA: The midpoint of the femoral head and the neck were marked and a line was drawn joining these two points. A vertical line was drawn passing through the tip of the greater trochanter to the inter-condylar notch. The angle formed by these lines was calculated as NSA. Results: The paired t-test for the inter-observer variability showed no significant difference between the values of two observers. (FNA: t=-1.06 and p=0.31; NSA: t=-0.09 and p=0.9). The FNA ranged from 17.08º to 33.97 º on right and 17.32 º to 45.08 º on left. The NSA ranged from 139.33 º to 124.91 º on right and 143.98 º to 123.8 º on left. Unpaired t-test was applied to compare the mean angles between the second and third trimesters which did not show any statistical significance. This shows that the FNA and NSA of femur did not vary significantly during the third trimester. The FNA and NSA were correlated with the GA using Pearson’s correlation. FNA appeared to increase with the GA (r=0.5) but the increase was not statistically significant. A decrease in the NSA was also noted with the GA (r=-0.3) which was also statistically not significant. Conclusion: The present study evaluates the FNA and NSA of the femur in fetuses and correlates their development with the GA during second and third trimesters. The FNA and NSA did not vary significantly during the third trimester.

Keywords: anteversion, coxa antetorsa, femoral torsion, femur neck shaft angle

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Authors: Weiyao Zhu, Qian Qi, Ming Yue, Dongxu Ma

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Due to the nano-micro pore structures and the massive multi-stage multi-cluster hydraulic fracturing in shale gas reservoirs, the multi-scale seepage flows are much more complicated than in most other conventional reservoirs, and are crucial for the economic development of shale gas. In this study, a new multi-scale non-linear flow model was established and simplified, based on different diffusion and slip correction coefficients. Due to the fact that different flow laws existed between the fracture network and matrix zone, a three-zone composite model was proposed. Then, according to the conformal transformation combined with the law of equivalent percolation resistance, the productivity equation of a horizontal fractured well, with consideration given to diffusion, slip, desorption, and absorption, was built. Also, an analytic solution was derived, and the interference of the multi-cluster fractures was analyzed. The results indicated that the diffusion of the shale gas was mainly in the transition and Fick diffusion regions. The matrix permeability was found to be influenced by slippage and diffusion, which was determined by the pore pressure and diameter according to the Knudsen number. It was determined that, with the increased half-lengths of the fracture clusters, flow conductivity of the fractures, and permeability of the fracture network, the productivity of the fractured well also increased. Meanwhile, with the increased number of fractures, the distance between the fractures decreased, and the productivity slowly increased due to the mutual interference of the fractures. In regard to the fractured horizontal wells, the free gas was found to majorly contribute to the productivity, while the contribution of the desorption increased with the increased pressure differences.

Keywords: multi-scale, fracture network, composite model, productivity

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Authors: Mohammad Arshad Ikram

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We report three cases of challenging fractures in children treated by intramedullary fixation using the Metaizeau method and achieved anatomical reduction with excellent clinical results. Jean-Paul Metaizeau described the centromedullary fixation for the radial neck in 1980 using K-wires Radial neck fractures are uncommon in children. Treatment of severely displaced fractures is always challenging. Closed reduction techniques are more popular as compared to open reduction due to the low risk of complications. Metaizeau technique of closed reduction with centromedullary pinning is a commonly preferred method of treatment. We present two cases with a severely displaced radial neck fracture, treated by this method and achieved sound union; anatomical position of the radial head and full function were observed two months after surgery. Proximal humerus fractures are another uncommon injury in children accounting for less than 5% of all pediatric fractures. Most of these injuries occur through the growth plate because of its relative weakness. Salter-Harris type I is commonly seen in the younger age group, whereas type II & III occurs in older children and adolescents. In contrast to adults, traumatic glenohumeral dislocation is an infrequently observed condition among children. A combination of proximal humerus fracture and glenohumeral dislocation is extremely rare and occurs in less than 2% of the pediatric population. The management of this injury is always challenging. Treatment ranged from closed reduction with and without internal fixation and open reduction with internal fixation. The children who had closed reduction with centromedullary fixation by the Metaizeau method showed excellent results with the return of full movements at the shoulder in a short time without any complication. We present the case of a child with anterior dislocation of the shoulder associated with a complete displaced proximal humerus metaphyseal fracture. The fracture was managed by closed reduction and then fixation by two centromedullary K-wires using the Metaizeau method, achieving the anatomical reduction of the fracture and dislocation. This method of treatment enables us to achieve excellent radiological and clinical results in a short time.

Keywords: glenohumeral, Metaizeau method, pediatric fractures, radial neck

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Authors: Armin Shirbazo, Hamed Lamei Ramandi, Mohammad Vahab, Jalal Fahimpour

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Hydraulic fracturing, especially multi-stage hydraulic fracturing, is a practical solution for wells with uneconomic production. The wide range of applications is appraised appropriately to have a stable well-production. Production logging tool, which is known as PLT in the oil and gas industry, is counted as one of the most reliable methods to evaluate the efficiency of fractures jobs. This tool has a number of benefits and can be used to prevent subsequent production failure. It also distinguishes different problems that occurred during well-production. In this study, the effectiveness of hydraulic fracturing jobs is examined by using the PLT in various cases and situations. The performance of hydraulically fractured wells is investigated. Then, the PLT is employed to gives more information about the properties of different layers. The PLT is also used to selecting an optimum fracturing design. The results show that one fracture and three-stage fractures behave differently. In general, the one-stage fracture should be created in high-quality areas of the reservoir to have better performance, and conversely, in three-stage fractures, low-quality areas are a better candidate for fracturing

Keywords: multi-stage fracturing, horizontal well, PLT, fracture length, number of stages

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Authors: Daniel Francis, Mo Yassin

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Transverse patella fractures are routinely fixed using tension band wiring (TBW) using Kirschner wires and a wire in the shape of a figure of 8. The idea of the study was to compare the outcomes of the traditional technique against the more recently used cannulated screws and fiber tape in the shape of a figure of 8. We performed a retrospective cohort study of all the surgically fixed patella fractures from the year 2019 to 2022. The patients were divided into two groups TBW group and cannulated screws group. The primary outcome measure was the failure of fixation and the need for the removal of metalwork. Twenty-six patellar fractures were studied. TBW was used in 14 (53.8%), and cannulated screws were used for fixation in 12 (46.2%). There was one incident of metalwork failure in the TBW and one incident in the cannulated screws group. Five (35.7%) of patients in the TBW needed symptomatic metal work removed and One (8.3%) in the cannulated screw group. In both groups, the rate of fixation failure was low. Symptomatic implants, the most common complication observed, were higher in the TBW group in our practice. Although the small numbers in both groups, the hope of this study is to shine the light on the use of cannulated screws for patella fractures as it would reduce the need for a second operation and reduce the load on the already stretched services as well as improving the patient experience by not requiring further surgery. Although this is not a brand-new technique, it is not commonly used as there have not yet been any studies that demonstrate the lower rates of second surgery needed.

Keywords: patella, tension band wiring, randomised, new technique

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Authors: Tony Feng, Rea Thomson, Kathryn Greenslade, Ross Medine, Jennifer Easterbrook, Calum Arthur, Matilda Powell-bowns

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There are clear guidelines on taking group and screen samples (G&S) for elective arthroplasty and major trauma. However, there is limited guidance on blood grouping for other trauma patients. The purpose of this study was to review the level of blood grouping at a major trauma centre and validate a protocol that limits the expensive processing of G&S samples. After reviewing the national guidance on transfusion samples in orthopaedic patients, data was prospectively collected for all orthopaedic admissions in the Royal Infirmary of Edinburgh between January to February 2023. The cause of admission, number of G&S samples processed on arrival and need for red cells was collected using the hospital blood bank. A new protocol was devised based on a multidisciplinary meeting which limited the requirement for G&S samples only to presentations in “category X”, including neck-of-femur fractures (NOFs), pelvic fractures and major trauma. A re-audit was completed between April and May after departmental education and institution of this protocol. 759 patients were admitted under orthopaedics in the major trauma centre across two separate months. 47% of patients were admitted with presentations falling in category X (354/759) and patients in this category accounted for 88% (92/104) of those requiring post-operative red cell transfusions. Of these, 51% were attributed to NOFs (47/92). In the initial audit, 50% of trauma patients outwith category X had samples sent (116/230), estimated to cost £3800. Of these 230 patients, 3% required post-operative transfusions (7/230). In the re-audit, 23% of patients outwith category X had samples sent (40/173), estimated to cost £1400, of which 3% (5/173) required transfusions. None of the transfusions in these patients in either audit were related to their operation and the protocol achieved an estimated cost saving of £2400 over one month. This study highlights the importance of sending samples for patients with certain categories of orthopaedic trauma (category X) due to the high demand for post-operative transfusions. However, the absence of transfusion requirements in other presentations suggests over-testing. While implementation of the new protocol has markedly reduced over-testing, additional interventions are required to reduce this further.

Keywords: blood transfusion, quality improvement, orthopaedics, trauma

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Authors: Tarek Duzan

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Fractures are a fundamental property of most reservoirs. Despite their abundance, they remain difficult to detect and quantify. The most effective characterization of fractured reservoirs is accomplished by integrating geological, geophysical, and engineering data. Detection of fractures and defines their relative contribution is crucial in the early stages of exploration and later in the production of any field. Because fractures could completely change our thoughts, efforts, and planning to produce a specific field properly. From the structural point of view, all reservoirs are fractured to some point of extent. North Gialo field is thought to be a naturally fractured reservoir to some extent. Historically, natural fractured reservoirs are more complicated in terms of their exploration and production efforts, and most geologists tend to deny the presence of fractures as an effective variable. Our aim in this paper is to determine the degree of fracturing, and consequently, our evaluation and planning can be done properly and efficiently from day one. The challenging part in this field is that there is no enough data and straightforward well testing that can let us completely comfortable with the idea of fracturing; however, we cannot ignore the fractures completely. Logging images, available well testing, and limited core studies are our tools in this stage to evaluate, model, and predict possible fracture effects in this reservoir. The aims of this study are both fundamental and practical—to improve the prediction and diagnosis of natural-fracture attributes in N. Gialo hydrocarbon reservoirs and accurately simulate their influence on production. Moreover, the production of this field comes from 2-phase plan; a self depletion of oil and then gas injection period for pressure maintenance and increasing ultimate recovery factor. Therefore, well understanding of fracturing network is essential before proceeding with the targeted plan. New analytical methods will lead to more realistic characterization of fractured and faulted reservoir rocks. These methods will produce data that can enhance well test and seismic interpretations, and that can readily be used in reservoir simulators.

Keywords: natural fracture, sandstone reservoir, geological, geophysical, and engineering data

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Authors: R. Hassan, J. Duncombe, E. Darke, A. Dias, K. Anderson, R. G. Middleton

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NHS England has set itself the task of delivering a “Net Zero” National Health service by 2040. It is incumbent upon all health care practioners to work towards this goal. Orthopaedic surgeons are no exception. Distal radial fractures are the most common fractures sustained by the adult population. However, studies are shortcoming on individual patient experience. The aim of this study was to assess the patient’s satisfaction and outcomes with woodcast used in the conservative management of distal radius fractures. For all patients managed with woodcast in our unit, we undertook a structured questionnaire that included the Patient Rated Wrist Evaluation (PRWE) score, The EQ-5D-5L score and the pain numerical score at the time of injury and six weeks after. 30 patients were initially managed with woodcast. 80% of patients tolerated woodcast for the full duration of their treatment. Of these, 20% didn’t tolerate woodcast and had their casts removed within 48 hours. Of the remaining, 79.1% were satisfied about woodcast comfort, 66% were very satisfied about woodcast weight, 70% were satisfied with temperature and sweatiness, 62.5% were very satisfied about the smell/odour, and 75% were satisfied about the level of support woodcast provided. During their treatment, 83.3% of patients rated their pain as five or less. For those who completed their treatment in woodcast, none required any further intervention or utilised the open appointment because of ongoing wrist problems. In conclusion, when woodcast is tolerated, patients’ satisfaction and outcome levels were good. However, we acknowledged 20% of patients in our series were not able to tolerate woodacst, Therefore, we suggest a comparison between the widely used synthetic plaster of Paris casting and woodcast to come in order.

Keywords: distal radius fractures, ecological cast, sustainability, woodcast

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Authors: Olivera Lupescu, Taina Elena Avramescu, Mihail Nagea, Alexandru Dimitriu

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Acetabular fractures represent a real challenge due to their impact upon the long term function of the hip joint, and due to the risk of intra- and peri-operative complications especially that they affect young, active people. That is why treating these fractures require certain skills which must be exercised, regarding the pre-operative planning, as well as the execution of surgery.The authors retrospectively analyse 38 cases with acetabular fractures operated using the posterior approach in our hospital between 01.01.2013- 01.01.2015 for which complete medical records ensure a follow-up of 24 months, in order to establish the main causes of potential errors and to underline the methods for preventing them. This target is included in the Erasmus + project ‘Collaborative learning for enhancing practical skills for patient-focused interventions in gait rehabilitation after orthopedic surgery COR-skills’. This paper analyses the pitfalls revealed by these cases, as well as the measures necessary to enhance the practical skills of the surgeons who perform acetabular surgery. Pre-op planning matched the intra and post-operative outcome in 88% of the analyzed points, from 72% at the beginning to 94% in the last case, meaning that experience is very important in treating this injury. The main problems detected for the posterior approach were: nervous complications - 3 cases, 1 of them a complete paralysis of the sciatic nerve, which recovered 6 months after surgery, and in other 2 cases intra-articular position of the screws was demonstrated by post-operative CT scans, so secondary screw removal was necessary in these cases. We analysed this incident, too, due to lack of information about the relationship between the screws and the joint secondary to this approach. Septic complications appeared in 3 cases, 2 superficial and 1 profound (requiring implant removal). The most important problems were the reduction of the fractures and the positioning of the screws so as not to interfere with the the articular space. In posterior acetabular fractures, pre-op complex planning is important in order to achieve maximum treatment efficacy with minimum of risk; an optimal training of the surgeons insisting on the main points of potential mistakes ensure the success of the procedure, as well as a favorable outcome for the patient.

Keywords: acetabular fractures, articular congruency, surgical skills, vocational training

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Authors: Mark T. Hanson, Alan T. Varughese

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Osteoporosis is a disease affecting bone quality which in turn can increase the risk of low energy fractures. Treatment of osteoporosis using Bisphosphonates has the beneficial effect of increasing bone mass while at the same time has been linked to the formation of atypical femoral fractures. This has led to the increased study of micro-fractures in bones of patients using Bisphosphonate treatment. One of the mechanics related issues which have been identified in this regard is the loss in stiffness of bones containing one or many micro-fractures. Different theories have been put forth using fracture mechanics to determine the effect of crack presence on elastic properties such as modulus. However, validation of these results in a deterministic way has not been forthcoming. The present analysis seeks to provide this deterministic evaluation of fracture’s effect on the elastic modulus. In particular, the effect of crack size, crack orientation and crack number on elastic modulus is investigated. In particular, the Finite Element method is used to explicitly determine the elastic modulus reduction caused by the presence of cracks in a representative volume element. Single cracks of various lengths and orientations are examined as well as cases of multiple cracks. Cracks in tension as well as under shear stress are considered. Although the focus is predominantly two-dimensional, some three-dimensional results are also presented. The results obtained show the explicit reduction in modulus caused by the parameters of crack size, orientation and number noted above. The present results allow the interpretation of the various theories which currently exist in the literature.

Keywords: cracks, elastic, fracture, modulus

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Authors: R. Hassan, J. Duncombe, E. Darke, A. Dias, K. Anderson, R. G. Middleton

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Background: NHS England has set itself the task of delivering a “Net Zero” National Health service by 2040. It is incumbent upon all health care practioners to work towards this goal. Orthopaedic surgeons are no exception. Distal radial fractures are the most common fractures sustained by the adult population. However, studiesare shortcoming on individual patient experience. The aim of this study was to assess the patient’ssatisfaction and outcomes with woodcast used in the conservative management of distal radius fractures. Methods: For all patients managed with woodcast in our unit, we undertook a structured questionnairethat included the Patient Rated Wrist Evaluation (PRWE) score, The EQ-5D-5L score, and the pain numerical score at the time of injury and six weeks after. Results: 30 patients were initially managed with woodcast.80% of patients tolerated woodcast for the full duration of their treatment. Of these, 20% didn’t tolerate woodcast and had their casts removed within 48 hours. Of the remaining, 79.1% were satisfied about woodcast comfort, 66% were very satisfied about woodcast weight, 70% were satisfied with temperature and sweatiness, 62.5% were very satisfied about the smell/odour, and 75% were satisfied about the level of support woodcast provided. During their treatment, 83.3% of patients rated their pain as five or less. Conclusion: For those who completed their treatment in woodcast, none required any further intervention or utilised the open appointment because of ongoing wrist problems. In conclusion, when woodcast is tolerated, patients’ satisfaction and outcome levels were good. However, we acknowledged 20% of patients in our series were not able to tolerate woodacst, Therefore, we suggest a comparison between the widely used synthetic plaster of Pariscasting and woodcast to come in order.

Keywords: distal radius fractures, ecological cast, sustainability, woodcast

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Authors: Babak Mirzashahi, Arvin Najafi, Pejman Mansouri, Mahmoud Farzan

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Background: The most effective treatment of posterior cruciate ligament (PCL) tears and the consequence of untreated PCL injuries remain controversial. Objectives: The aim of this study is to assess outcomes of fixation of tibial posterior cruciate ligament (PCL) avulsion fractures via a modified technique. Patients and Methods: From January, 2009 to March, 2012, there were 45 cases of PCL tibial avulsion fractures that were referred to our hospital and were managed through a modified open posterior approach. Fixation of Tibial PCL avulsion fractures were fixed by means of a lag screw and washer placed through our modified open posterior approach. Range of motion was begun on the first postoperative day. Clinical stability, range of motion, gastrocnemius muscle strength, radiographic investigation, and patient’s overall quality of life was analyzed at final follow up visit. Results: The average of overall musculoskeletal functional evaluation scores was 15 (range 3–35). All patients achieved union of their fracture and had clinically stable knees at the latest follow-up. The mean preoperative Lysholm score for 15 knees was 62 ± 8 (range, 50-75); the mean postoperative Lysholm score was 92± 7 (range, 75-101). A significant difference in Lysholm scores between preoperative and final follow-up evaluations was found (P < .05). At first-year follow-up, 42 (93%) patients revealed a difference of less than 10 mm in thigh circumference between their injured and healthy knees. Conclusions: The management of displaced large PCL avulsion fractures with placement of a cancellous lag screw with washer by means of the modified open posterior approach leads to satisfactory clinical, radiographic, and functional results and reduces the operation time and less blood loss. Level of evidence: IV.

Keywords: posterior cruciate ligament, tibial fracture, lysholm knee score, patient outcome assessment

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Authors: Hong Li, Haiyang Yu, Shiqing Cheng, Nai Cao, Zhiliang Shi

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Unconventional resources have gradually become the main direction for oil and gas exploration and development. However, the productivity of gas wells, the level of water production, and the seepage law in tight fractured gas reservoirs are very different. These are the reasons why production prediction is so difficult. Firstly, a three-dimensional multi-scale fracture and multiphase mathematical model based on an embedded discrete fracture model (EDFM) is established. And the material balance method is used to calculate the water body multiple according to the production performance characteristics of water-producing gas well. This will help construct a 'virtual water body'. Based on these, this paper presents a numerical simulation process that can adapt to different production modes of gas wells. The research results show that fractures have a double-sided effect. The positive side is that it can increase the initial production capacity, but the negative side is that it can connect to the water body, which will lead to the gas production drop and the water production rise both rapidly, showing a 'scissor-like' characteristic. It is worth noting that fractures with different angles have different abilities to connect with the water body. The higher the angle of gas well development, the earlier the water maybe break through. When the reservoir is a single layer, there may be a stable production period without water before the fractures connect with the water body. Once connected, a 'scissors shape' will appear. If the reservoir has multiple layers, the gas and water will produce at the same time. The above gas-water relationship can be matched with the gas well production date of the Xujiahe gas reservoir in the Sichuan Basin. This method is used to predict the productivity of a well with hydraulic fractures in this gas reservoir, and the prediction results are in agreement with on-site production data by more than 90%. It shows that this research idea has great potential in the productivity prediction of water-producing gas wells. Early prediction results are of great significance to guide the design of development plans.

Keywords: EDFM, multiphase, multilayer, water body

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Authors: Meysam Lak, Mohammad Fatehi Marji, Alireza Yarahamdi Bafghi, Abolfazl Abdollahipour

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A wellbore is a hole that is drilled to aid in the exploration and recovery of natural resources including oil and gas. Occasionally, in order to increase productivity index and porosity of the wellbore and reservoir, the well stimulation methods have been used. Hydraulic fracturing is one of these methods. Moreover, several explosions at the end of the well can stimulate the reservoir and create fractures around it. In this study, crack initiation in rock around the wellbore has been numerically modeled due to explosion. One, two, three, and four pairs of explosion have been set at the end of the wellbore on its wall. After each stage of the explosion, results have been presented and discussed. Results show that this method can initiate and probably propagate several fractures around the wellbore.

Keywords: crack initiation, explosion, finite difference modelling, well productivity

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Authors: William Elnemer, Nauman Hussain, Samir Al-Ali, Henry Shu, Diane Ghanem, Babar Shafiq

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Introduction: The incidence of infection in open tibial shaft injuries varies depending on the severity of the injury, with rates ranging from 1.8% for Gustilo-Anderson type I to 42.9% for type IIIB fractures. The timely administration of antibiotics upon presentation to the emergency department (ED) is an essential component of fracture management, and evidence indicates that prompt delivery of antibiotics is associated with improved outcomes. The objective of this study is to identify factors that contribute to the expedient administration of antibiotics. Methods: This is a retrospective study of open tibial shaft fractures at an academic Level I trauma center. Current Procedural Terminology (CPT) codes identified all patients treated for open tibial shaft fractures between 2015 and 2021. Open fractures were identified by reviewing ED and provider notes, and with ballistic fractures were considered open. Chart reviews were performed to extract demographics, fracture characteristics, postoperative outcomes, time to operative room, time to antibiotic order, and delivery. Univariate statistical analysis compared patients who received early antibiotics (EA), which were delivered within one hour of ED presentation, and those who received late antibiotics (LA), which were delivered outside of one hour of ED presentation. A multivariate analysis was performed to investigate patient, fracture, and transport/ED characteristics contributing to faster delivery of antibiotics. The multivariate analysis included the dependent variables: ballistic fracture, activation of Delta Trauma, Gustilo-Andersen (Type III vs. Type I and II), AO-OTA Classification (Type C vs. Type A and B), arrival between 7 am and 11 pm, and arrival via Emergency Medical Services (EMS) or walk-in. Results: Seventy ED patients with open tibial shaft fractures were identified. Of these, 39 patients (55.7%) received EA, while 31 patients (44.3%) received LA. Univariate analysis shows that the arrival via EMS as opposed to walk-in (97.4% vs. 74.2%, respectively, p = 0.01) and activation of Delta Trauma (89.7% vs. 51.6%, respectively, p < 0.001) was significantly higher in the EA group vs. the LA group. Additionally, EA cases had significantly shorter intervals between the antibiotic order and delivery when compared to LA cases (0.02 hours vs. 0.35 hours, p = 0.007). No other significant differences were found in terms of postoperative outcomes or fracture characteristics. Multivariate analysis shows that a Delta Trauma Response, arrival via EMS, and presentation between 7 am and 11 pm were independent predictors of a shorter time to antibiotic administration (Odds Ratio = 11.9, 30.7, and 5.4, p = 0.001, 0.016, and 0.013, respectively). Discussion: Earlier antibiotic delivery is associated with arrival to the ED between 7 am and 11 pm, arrival via EMS, and a coordinated Delta Trauma activation. Our findings indicate that in cases where administering antibiotics is critical to achieving positive outcomes, it is advisable to employ a coordinated Delta Trauma response. Hospital personnel should be attentive to the rapid administration of antibiotics to patients with open fractures who arrive via walk-in or during late-night hours.

Keywords: antibiotics, emergency department, fracture management, open tibial shaft fractures, orthopaedic surgery, time to or, trauma fractures

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Authors: Meltem Nur Erdöl, Feyzanur Bayrak, Elif Emanetçi, Faik Nüzhet Oktar, Cevriye Kalkandelen, Oğuzhan Gündüz

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Nowadays, the bioceramic graft applications are very important due to the fact that especially European population is getting much older. Consequently, healing approaches for some health problems become more important in the near future. For instance, osteoporosis is one of the reasons for serious hip fractures. Beside these, the traffic accidents playing role increasing of various hip fractures and other bone fractures. Naturally all these are leading the importance developing new bioceramic graft materials. Hydroxyapatite (HA) is one of the leading bioceramics on the market. Beside the high biocompatibility HA bioceramics unfortunately are weak materials for loaded areas. For improvement mechanical properties of HA material, some oxides and metallic powders can be added. In this study, some rare earth oxides like hafnium (IV) oxide (HfO₂) and samarium (III) oxide (Sm₂O₃) are added to HA for improvement of their material characteristics. Thus, compression, microhardness and theoretical density tests are performed. X-ray diffraction patterns are also investigated corresponding x-ray diffraction equipment. At the end, studies of scanning electron microscope (SEM) and energy-dispersive x-ray spectroscopy (EDX) are completed. All values were compared with past BHA and various composites.

Keywords: biocomposite, hafnium oxide, hydroxyapatite, nanotechnology, samarium oxide

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Authors: M. Wigwe, M. Y Soloman, E. Pirayesh, R. Eghorieta, N. Stegent

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The moving reference point (MRP) technique has been used in the analyses of the first three stages of two fracturing jobs. The results obtained verify the proposition that a hydraulic fracture in shale grows in spurts rather than in a continuous pattern as originally interpreted by Nolte-Smith technique. Rather than a continuous Mode I fracture that is followed by Mode II, III or IV fractures, these fracture modes could alternate throughout the pumping period. It is also shown that the Nolte-Smith time parameter plot can be very helpful in identifying the presence of natural fractures that have been intersected by the hydraulic fracture. In addition, with the aid of a fracture length-time plot generated from any fracture simulation that matches the data, the distance from the wellbore to the natural fractures, which also translates to the actual fracture length for the stage, can be determined. An algorithm for this technique is developed. This procedure was used for the first 9 minutes of the simulated frac job data. It was observed that after 7mins, the actual fracture length is about 150ft, instead of 250ft predicted by the simulator output. This difference gets larger as the analysis proceeds.

Keywords: shale, fracturing, reservoir, simulation, frac-length, moving-reference-point

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Authors: Patricia Shirley Almeida Prado, Selma Paixão Argollo, Maria De Fátima Teixeira Guimarães, Leticia Matos Sobrinho

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Skeletal differential diagnosis is essential in forensic anthropology in order to differentiate skeletal trauma from normal osseous variation and pathological processes. Thus, part of forensic anthropological field is differentiate skeletal criminal injuries from the normal skeletal variation (bone fusion or nonunion, transitional vertebrae and other non-metric traits), non-traumatic skeletal pathology (myositis ossificans, arthritis, bone metastasis, osteomyelitis) from traumatic skeletal pathology (myositis ossificans traumatic) avoiding misdiagnosis. This case shows the importance of effective pathological diagnosis in order to accelerate the identification process of skeletonized human remains. THE CASE: An unidentified skeletal remains at the medico legal institute Nina Rodrigues-Salvador, of a male young adult (29 to 40 years estimated) showing a massive heterotopic ossification on its right tibia at upper epiphysis and adjacent articular femur surface; an extensive ossification on the right clavicle (at the sternal extremity) also presenting an heterotopic ossification at right scapulae (upper third of scapulae lateral margin and infraglenoid tubercule) and at the head of right humerus at the shoulder joint area. Curiously, this case also shows an unusual porosity in certain vertebrae´s body and in some tarsal and carpal bones. Likewise, his left fifth metacarpal bones (right and left) showed a healed fracture which led both bones distorted. Based on identification, of pathological conditions in human skeletal remains literature and protocols these alterations can be misdiagnosed and this skeleton may present more than one pathological process. The anthropological forensic lab at Medico-legal Institute Nina Rodrigues in Salvador (Brazil) adopts international protocols to ancestry, sex, age and stature estimations, also implemented well-established conventions to identify pathological disease and skeletal alterations. The most compatible diagnosis for this case is hematogenous osteomyelitis due to following findings: 1: the healed fracture pattern at the clavicle showing a cloaca which is a pathognomonic for osteomyelitis; 2: the metacarpals healed fracture does not present cloaca although they developed a periosteal formation. 3: the superior articular surface of the right tibia shows an extensive inflammatory healing process that extends to adjacent femur articular surface showing some cloaca at tibia bone disease. 4: the uncommon porosities may result from hematogenous infectious process. The fractures probably have occurred in a different moments based on the healing process; the tibia injury is more extensive and has not been reorganized, while metacarpals and clavicle fracture is properly healed. We suggest that the clavicle and tibia´s fractures were infected by an existing infectious disease (syphilis, tuberculosis, brucellosis) or an existing syndrome (Gorham’s disease), which led to the development of osteomyelitis. This hypothesis is supported by the fact that different bones are affected in diverse levels. Like the metacarpals that do not show the cloaca, but then a periosteal new bone formation; then the unusual porosities do not show a classical osteoarthritic processes findings as the marginal osteophyte, pitting and new bone formation, they just show an erosive process without bone formation or osteophyte. To confirm and prove our hypothesis we are working on different clinical approaches like DNA, histopathology and other image exams to find the correct diagnostic.

Keywords: bone disease, forensic anthropology, hematogenous osteomyelitis, human identification, human remains

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