Search results for: pelvic fracture

Authors: S. Alireza Mirghasemi, Narges Rahimi Gabaran

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Although sacral fractures in children are rare due to the fact that the occurrence of pelvic fracture is not common in childhood. Sacral fractures present a high risk of neurological damage. This kind of fracture is often missed because the routine pelvic X-rays imaging scarcely show this fracture. Also, the treatment is controversial, and it ranges from fine reduction to conservative treatments without any try to reduce the dislocation. In this article, a case of fracture dislocation of S1 and S2 along with a suggested diagnostic test and treatment based on similar cases are presented. The case investigates a 14-year-old boy who entered the hospital one week after a car accident that knocked him to the ground in crawling position and a rack fell down on his body. Pain and tenderness in the sacral region and a fracture in the left leg were notable--we detected incomplete bilateral palsy of L5, S1 and S2 roots. In radiographs of the spine fracture dislocation of S1, the sacral fracture was seen. The treatment included a skeletal traction with a halo over the patient’s head and two femoral pins. After one week, another surgery was performed in order to stabilize and reduce the fracture, and we employed a posterior approach with CD and a pedicular screw. After two years of follow-up, the fracture is completely cured without any loss of reduction.

Keywords: adolescent, fracture in adolescent, fracture dislocation, sacrum

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Authors: Blake Milton, Georgette Goode, Elias Sachawars, Virgil Chan, Jason Dizon, Christopher Oldmeadow, Garbor Major

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Fragility fractures of the pelvis (FFP) are a common and increasing fracture type in our ageing population. A novel grading classification system developed for FFP by Rommens and Hofmann attributes a severity score related to degree of pelvic ring involvement, which is assessed on CT imaging. The purpose of this study is to assess the relationship between radiologist-assigned FFP grading and patient mortality in conservatively managed patients. This retrospective review identified consecutive 100 patients aged ≥ 65 years at time of FFP. The Rommens-Hofmann severity grading was allocated to these injuries by 2 radiology trainees and a consultant radiologist. Five-year survival was determined from review of patient medical records. Patient medical records were also analysed to account for possible confounding factors including age, gender, comorbidities (Charlson score) and relative socio-economic disadvantage (SEIFA decile). Suitable FFP’s (n = 99) were classified by increasing severity by increasing severity grades: Type I (43% (n = 43)), Type II (33% (n = 33)), Type III (13% (n = 13)), Type IV (10% (n = 10)). No significant differences in survival were found between fracture groups, which persisted when also adjusting for age, gender, Charslon score or SEIFA decile. There was a lack of evidence to suggest a relationship between CT-based fracture grading and patient survival, even when accounting for the listed possible confounding factors. This may be due to small sample size or possible study biases, or possible heterogeneity within the population not adequately captured with available metrics. Given that no difference in mortality has been identified between FFP grades in conservatively managed patients, further research is important to assess mortality benefit in an operative patient population.

Keywords: fragility fractures, fracture classification, pelvic CT, pelvic fracture, pelvic ring fracture

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Authors: Mohamed Taher Eldesoky, Enas Elsayed Abutaleb

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Background: The changes in foot posture possibly generate changes in the pelvic alignment, although, there is lack of evidence about the effects of bilateral and unilateral flatfoot on possible changes in pelvic alignment. The purpose of this study was to investigate the effect of flatfoot on the sagittal and frontal planes of pelvic postures. Materials and Methods: 56 subjects, aged 18–40 years, were assigned into three groups. 20 healthy subjects, 19 subjects with bilateral flexible second-degree flat foot, and 17 subjects with unilateral flexible second-degree flat foot. 3D assessment of the pelvis using the formetric-II device was used to evaluate pelvic alignment in the frontal and sagittal planes by measuring pelvic inclination and pelvic tilt angles. Results: ANOVA test with LSD test were used for statistical analysis. Both Unilateral and bilateral second degree flatfoot produced significant (P < 0.05) pelvic anteversion in comparison to the healthy subjects (P < 0.05), but the bilateral flatfoot subjects seemed to have more anteversion than the unilateral subjects. Unilateral flatfoot caused a significant (P<0.05) lateral pelvic tilt in the direction of the affected side in comparison to the healthy and bilateral flatfoot subjects. Conclusion: The bilateral and unilateral second degree flatfoot changed pelvic alignment. Both of them led to increases of pelvic anteversion while the unilateral one caused lateral pelvic tilt toward the affected side. Thus, foot posture should be considered when assessing patients with pelvic misalignment and disorders.

Keywords: bilateral flatfoot, unilateral flatfoot, pelvic alignment, foot posture

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Authors: Osama Zayed

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Aim of the work: The aim of this study is to assess the predictors of pelvic vascular injuries in patients with pelvic fractures from major blunt trauma. Methods: This study was conducted as a tool-assessment study. Forty six patients with pelvic fractures from major blunt trauma will be recruited to the study arriving to department of emergency, Suez Canal University Hospital. Data were collected from questionnaire including; personal data of the studied patients and full medical history, clinical examinations, outcome measures (The Physiological and Operative Severity Score for enumeration of Mortality and morbidity (POSSUM), laboratory and imaging studies. Patients underwent surgical interventions or further investigations based on the conventional standards for interventions. All patients were followed up during conservative, operative and post-operative periods in the hospital for interpretation the predictive scores of vascular injuries. Results: Significant predictors of vascular injuries according to computed tomography (CT) scan include age, male gender, lower Glasgow coma (GCS) scores, occurrence of hypotension, mortality rate, higher physical POSSUM scores, presence of ultrasound collection, type of management, higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) POSSUM scores, presence of abdominal injuries, and poor outcome. Conclusions: There was higher frequency of males than females in the studied patients. There were high probability of morbidity and low probability of mortality among patients. Our study demonstrates that POSSUM score can be used as a predictor of vascular injury in pelvis fracture patients.

Keywords: predictors, pelvic vascular injuries, pelvic fractures, major blunt trauma, POSSUM

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Authors: Iwona Kasior

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Purpose: Pelvic organ prolapse is the descent of pelvic organs into the vaginal opening. Currently, few trials have been conducted to determine the influence of pelvic floor muscle training in decreasing stage or symptoms associated with pelvic organ prolapse. The purpose of this case study is to determine whether pelvic floor muscle training can decrease the stage of pelvic organ prolapse and related symptoms. Case Presentation: This is the case of a 55-year-old female; recently diagnosed with midline cystocele, stage three. She has undergone corrective surgery that failed. She has now resorted to managing the condition with a home exercise regimen of voluntary pelvic floor muscle contractions, topical vaginal crème prescribed by her gynecologist, and slight lifestyle modifications. Methods: The patient was treated by a physical therapist for evaluation, vaginal exam, and educated in the ‘knack’ maneuver, lifestyle modifications, and proper technique of performing pelvic floor muscle contractions. The subject continued with a home exercise program with a specific regimen of pelvic floor muscle contractions and topical vaginal crème. Outcome: As determined by her physical therapist and the subject, her pelvic floor muscle strength had increased following the pelvic floor muscle training regimen and the use of the ‘knack’ maneuver. The subject reported a small decrease in the size of bulging prolapse and related symptoms of dryness, odor, vaginal discomfort, and the sensation of descent. Conclusion: Pelvic floor muscle training helped to lessen the degree of the prolapse, but not significantly enough to decrease the diagnosed stage.

Keywords: Kegel exercises, pelvic floor, pelvic organ prolapse, physical therapy

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Authors: Suvorov Vasyl, Filipchuk Viktor

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Developmental Dysplasia of the Hip (DDH) is a frequent pathology in pediatric orthopedist’s practice. Neglected or residual cases of DDH in walking patients are usually treated using pelvic osteotomies. Plastic changes take place in hinge points due to acetabulum reorientation during surgery. Classically described hinge points and a traditional division of pelvic osteotomies on reshaping and reorientation are currently debated. The purpose of this article was to evaluate biomechanical changes during the most commonly used pelvic osteotomies (Salter, Dega, Pemberton) for DDH treatment in pediatric patients. Methods: virtual pelvic models of 2- and 6-years old patients were created, material properties were assigned, pelvic osteotomies were simulated and biomechanical changes were evaluated using finite element analysis (FEA). Results: it was revealed that the patient's age has an impact on pelvic bones and cartilages density (in younger patients the pelvic elements are more pliable - p<0.05). Stress distribution after each of the abovementioned pelvic osteotomy was assessed in 2- and 6-years old patients’ pelvic models; hinge points were evaluated. The new term "restriction point" was introduced, which means a place where restriction of acetabular deformity correction occurs. Pelvic ligaments attachment points were mainly these restriction points. Conclusions: it was found out that there are no purely reshaping and reorientation pelvic osteotomies as previously believed; the pelvic ring acts as a unit in carrying out the applied load. Biomechanical overload of triradiate cartilage during Salter osteotomy in 2-years old patient and in 2- and 6-years old patients during Pemberton osteotomy was revealed; overload of the posterior cortical layer in the greater sciatic notch in 2-years old patient during Dega osteotomy was revealed. Level of Evidence – Level IV, prognostic.

Keywords: developmental dysplasia of the hip, pelvic osteotomy, finite element analysis, hinge point, biomechanics

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Authors: Viyango Pandian, Kumaresh Athiyappan

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Pelvic congestion Syndrome (PCS) is usually seen in multiparous women who give history of chronic dull-aching pelvic pain. We report a case of a 17 year old unmarried female, who presented with acute onset of chronic dull-aching abdominal pain in the left iliac fossa, which particularly increased during menstruation and was finally diagnosed to be pelvic congestion syndrome. On ultrasonography, multiple tortuous and dilated veins were observed in the left adnexa. Both ovaries appeared normal in size, volume and echotexture. Computed tomography (CT) angiography was performed to precisely delineate the venous pathway and to assess any associated abnormality; which showed a dilated and tortuous left ovarian vein with an anomalous course around the left kidney and draining into the left renal vein. Clinical parameters and hormonal levels were within normal limits. This is a rare case of anomalous course of left ovarian vein associated with pelvic congestion syndrome.

Keywords: anomalous course of ovarian vein, computed tomography, pelvic congestion syndrome, ultrasonography

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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: P. Sathyathas, H. M. I. S. W. Herath, T. Amalraj, U. J. M. A. L. Jayasinghe

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Over two thirds of medical radiation can now be attributed to Computed Tomography (CT). There is little information on amount of radiation received from multiphase CT scan of abdomen- pelvic region in clinical practice. We sought to estimate the radiation dose and associated exposure parameters in the multiphase abdomen - pelvic scan of Multideteror Computed Tomography (MDCT) studies in clinical practice. This was a retrospective cross sectional studies describing radiation dose associated with main exposure parameters in diagnostic multiphase abdomen - pelvic scans performed on 152 consecutive patients by two different sixteen slice CT scanners. Patient information, exposure parameters of CTDI (volume), DLP, kVp, mAs and pitch were recorded for every phases of abdomen- a pelvic study from dose report of MDCT scanners (MDCTs). Age of patients range from 14 years to 87 years in both MDCT scanners. Overall CTDI (volume) median was 63.8 (±10.4) mGy for a multiphase abdominal-pelvic scan with scanner A while it was 35.4 (±15.6) mGy for scanner B. Patients' effective dose for multiphase abdomen - pelvic CT scan range from 8.2 mSv to 58 mSv. Median effective dose for patients, who underwent multiphase abdomen- pelvis scan with scanner A and B were 38.5 (± 8.2) mSv and 21.3 (± 8.6) mSv respectively. Median value of exposure parameters of mAs, kVp and pitch, were 150 (±29.7), 130 (±15.3) and 1.3 (±0.1) respectively in scanner A. In scanner B; they were 60 (±14.5), 120 and 1. The median effective dose for patients between multiphase abdomen-pelvic scan of both MDCT, a significant different (P<0.05) was observed. Multiphase abdomen – pelvic scan of clinical study shows significant different of effective dose with reference level of phantom studies (8-14mSv) and it depends on the type of vendors.

Keywords: abdomen-pelvic region, computed tomography, exposure parameters, radiation dose

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Authors: Ahmad N. Shuid, Azri Jalil, Sabarul A. Mokhtar, Mohd F. Khamis, Norliza Muhammad

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Micro-CT provides a 3-D image of fracture callus, which can be used to calculate quantitative parameters. In this study, micro-CT was used to assess the fracture healing of orchidectomised rats, an androgen-deficient osteoporosis model. The effect of testosterone (hormone replacement) on fracture healing was also assessed with micro-CT. The rats were grouped into orchidectomised-control (ORX), sham-operated (SHAM), and orchidectomised; and injected with testosterone intramuscularly once weekly (TEN). Treatment duration was six weeks. The fracture was induced and fixed with plates and screws in the right tibia of all the rats. An in vitro micro-CT was used to scan the fracture callus area which consisted of 100 axial slices above and below fracture line. The analysis has shown that micro-CT was able to detect a significant difference in the fracture healing rate of ORX and TEN groups. In conclusion, micro-CT can be used to assess fracture healing in androgen-deficient osteoporosis. This imaging tool can be used to test agents that influence fracture healing in the androgen-deficient model.

Keywords: androgen, fracture, orchidectomy, osteoporosis

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Authors: Ravid Yinon

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Introduction: Pelvic trauma causes high mortality, particularly among the elderly population. Pelvic injury ranges from low-energy incidents such as falls to high-energy trauma like motor vehicle accidents. The mortality rate among high-energy trauma patients is higher, as can be expected. The elderly population is more vulnerable to pelvic trauma even at low energy mechanisms due to the fragility and diminished physiological reserve of these patients. The aim of this study is to examine whether there is a higher long-term mortality in pelvic injuries in the elderly from the low-energy mechanism than those injured in high energy. Methods: A retrospective cohort study was conducted in a level 1 trauma center with injured patients aged 65 years and over with pelvic trauma. The patients were divided into two groups of low and high-energy mechanisms of injury. Multivariate analysis was conducted to characterize the differences between the groups. Results: There were 585 consecutive injured patients over the age of 65 with a documented pelvic injury who were treated at the primary trauma center between 2008-2020. The injured in the high energy group were younger (mean HE- 75.18, LE-80.73), with fewer comorbidities (mean 0.78 comorbidities at HE and 1.28 at LE), more men (52.6% at HE and 27.4% at LE), were consumed more treatments facilities such as angioembolization, ICU admission, emergency surgeries and blood products transfusion and higher mortality rate at admission (HE- 19/133, 14.28%, LE- 10/452, 2.21%) compared to the low energy group. However, in a long-term follow-up of one year after the injury, mortality in the low-energy group was significantly higher (HE- 14/114, 12.28%, LE- 155/442, 35.06%). Discussion: Although it can be expected that in the mechanism of high energy, the mortality rate in the long term would be higher, it was found that mortality at the low energy patient was higher. Apparently, low-energy pelvic injury in geriatric patients is a measure of frailty in these patients, causes injury to more frail and morbid patients, and is a predictor of mortality in this population in the long term. Conclusion: The long-term follow-up of injured elderly with pelvic trauma should be more intense, and the healthcare provider should put more emphasis on the rehabilitation of these special patient populations in an attempt to prevent long-term mortality.

Keywords: pelvic trauma, elderly trauma, high energy trauma, low energy trauma

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Authors: Enas El Sayed Abutaleb, Mohamed Taher Eldesoky, Shahenda Abd El Rasol

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Background: Muscle energy techniques (MET) have been widely used by manual therapists over the past years, but still limited research validated its use and there was limited evidence to substantiate the theories used to explain its effects. Objective: To investigate the effect of muscle energy technique (MET) on anterior pelvic tilt in patients with lumbar spondylosis. Design: Randomized controlled trial. Subjects: Thirty patients with anterior pelvic tilt from both sexes were involved, aged between 35 to 50 years old and they were divided into MET and control groups with 15 patients in each. Methods: All patients received 3 sessions/week for 4 weeks where the study group received MET, Ultrasound and Infrared, and the control group received U.S and I.R only. Pelvic angle was measured by palpation meter, pain severity by the visual analogue scale and functional disabilities by the Oswestry disability index. Results: Both groups showed significant improvement in all measured variables. The MET group was significantly better than the control group in pelvic angle, pain severity, and functional disability as p-value were (0.001, 0.0001, 0.0001) respectively. Conclusion and implication: The study group fulfilled greater improvement in all measured variables than the control group which implies that application of MET in combination with U.S and I.R were more effective in improving pelvic tilting angle, pain severity and functional disabilities than using electrotherapy only.

Keywords: anterior pelvic tilt, lumbar spondylosis, muscle energy technique exercise, pelvic tilting angle

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Authors: Suk Kyoon Song, Myung-Rae Cho

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Purpose: Paralytic ileus occurs in up to 18% of patients with pelvic bone fractures. The aim of this study is to determine if massive bleeding requiring arterial angioembolization is related to the duration of ileus in patients with traumatic pelvic ring injuries. Methods: This retrospective study included 25 patients who underwent arterial angioembolization for traumatic pelvic ring injuries. Data were collected from prospectively maintained databases of two independent hospitals. Results: Demographic characteristics (such as age, sex, body mass index, and Charlson Comorbidity Index), cause of trauma, and severity of pelvic injuries were similar in the non-prolonged and prolonged ileus groups. As expected, the prolonged ileus group had a significantly longer duration of ileus than the non-prolonged ileus group (8.0 ± 4.2 days vs. 1.2 ± 0.4 days, respectively, P < 0.001). The mortality rate was higher in the prolonged ileus group (20% vs. 0%), but it was not significantly different (P = 0.13). Interestingly, the prolonged ileus group received significantly higher amounts of packed red blood cell (PRBC) transfusions (6.1 ± 2.1 units vs. 3.8 ± 2.5 units; P = 0.02). The amount of PRBC transfusions was associated with a greater risk of prolonged ileus development (P = 0.03, OR = 2.04, 95% CI = 1.08-3.88). Conclusion: This study supports the idea that the duration of the ileus is related to the amount of bleeding caused by the traumatic pelvic ring injury. In order to prevent further complications, conservative treatments of the ileus should be considered.

Keywords: pelvic ring injury, bleeding, ileus, arterial angioembolization

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Authors: Reham H. Diab, Amira A. A. Abdallah, Eman A. Embaby

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Background: The effectiveness of bracing on preventing spino-pelvic alignment deterioration in idiopathic scoliosis has been extensively studied especially in the frontal plane. Yet, there is lack of knowledge regarding the effect of soft braces on spino-pelvic alignment in the sagittal plane. Achieving harmonious sagittal plane spino-pelvic balance is critical for the preservation of physiologic posture and spinal health. Purpose: This study examined the kyphotic angle, lordotic angle and pelvic inclination in the sagittal plane and trunk imbalance in the frontal plane before and after a six-month rehabilitation period. Methods: Nineteen patients with idiopathic scoliosis participated in the study. They were divided into two groups; experimental and control. The experimental group (group I) used the SpineCor brace in addition to a rehabilitation exercise program while the control group (group II) had the exercise program only. The mean ±SD age, weight and height were 16.89±2.15 vs. 15.3±2.5 years; 59.78±6.85 vs. 62.5±8.33 Kg and 162.78±5.76 vs. 159±5.72 cm for group I vs. group II. Data were collected using for metric Π system. Results: Mixed design MANOVA showed that there were significant (p < 0.05) decreases in all the tested variables after the six-month period compared with “before” in both groups. Moreover, there was a significant decrease in the kyphotic angle in group I compared with group II after the six-month period. Interpretation and conclusion: SpineCor brace is beneficial in reducing spino-pelvic alignment deterioration in both sagittal and frontal planes.

Keywords: adolescent idiopathic scoliosis, SpineCor, spino-pelvic alignment, biomechanics

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Authors: Rajesh Bansal, Amit Raj Sharma, Vakil Singh

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The success and predictability of titanium implants for long durations are well established and there has been a tremendous increase in the popularity of implants among patients as well as clinicians over the last four decades. However, sometimes complications arise, which lead to the loss of the implant as well as the prosthesis. Fracture of dental implants is rare; however, at times, implants or abutment screws fracture and lead to many problems for the clinician and the patient. Possible causes of implant fracture include improper design, overload, fatigue and corrosion. Six retrieved fractured dental implants, with varying diameters and designs, were collected from time to time to examine by scanning electron microscope (SEM) to characterize fracture behavior and assess the mechanism of fracture. In this investigation, it was observed that fracture of the five dental implants occurred due to fatigue crack initiation and propagation from the thread roots.

Keywords: titanium, dental, implant, fracture, failure

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Authors: Guoyang Fu, Wei Yang, Chun-Qing Li

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The most common type of cracks that appear on metal pipes is longitudinal cracks. For ductile metal pipes, the existence of plasticity eases the stress intensity at the crack front and consequently increases the fracture resistance. It should be noted that linear elastic fracture mechanics (LEFM) has been widely accepted by engineers. In order to make the LEFM applicable to ductile metal materials, the increase of fracture toughness due to plasticity should be excluded from the total fracture toughness of the ductile metal. This paper aims to develop a model of elastic fracture toughness for ductile metal pipes with external longitudinal cracks. The derived elastic fracture toughness is a function of crack geometry and material properties of the cracked pipe. The significance of the derived model is that the well-established LEFM can be used for ductile metal material in predicting the fracture failure.

Keywords: Ductile metal pipes, elastic fracture toughness, longitudinal crack, plasticity

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Authors: Rajendra Kumar Kanojia

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Treatment of fracture both bones of leg following trauma is done intially at nearby primary health care center.primary management for shock,pain,control of bleeding,plaster application. These are treated for primay fixation of fracture, debridment of wound. Then, they were refered to tertiary care where they were again and planned for further treatment. This leads to loss of lot of time, money, job, etc.

Keywords: fracture both bones leg, non-union, ilizarov, cost

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Authors: Nawaf Al-Kharashi, Waseem Al-Talalwah, Shorok Al Dorazi, Roger Soames

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Superior gluteal artery is one of the largest branches of posterior division of the internal iliac artery. It passes between the lumbosacral and first sacral root to escape from the pelvic cavity through the grater sciatic foramen just above the piriformis. The current study includes 41 cadaver investigates the origin and branch of the superior gluteal artery and clarify the clinical significance. In present study, the superior gluteal artery arises from the posterior division of the internal iliac artery directly in 82.5% whereas it arises indirectly as from the sciatic artery in 15.9%. However, it is congenital absence in 1.6% which is compensated by sciatic artery. The sciatic nerve gains vascular supply from superior gluteal artery in two ways either during its course or giving lateral sacral artery in 27% and lumbar branches in 1.6%. It also supplies the adductors group and iliacus via giving obturator artery in 14.3% and in 1.6% respectively. The superior gluteal artery usually passes between lumbosacral trunk and first sacral root in 82.5% whereas it does not passes the sciatic roots as it arises behind them in 15.9%. With a variability of the superior gluteal artery origin, there is a variability of sciatic nerve roots supply. Further, the superior gluteal artery arising from sciatic artery behind the sciatic roots carries a high risk of intra-pelvic bleeding in case of posterior pelvic fracture. Prolonged ligation of the superior gluteal artery which gives lateral sacral artery may result in sciatic neuropathy. Therefore, surgeons have to be aware of the superior gluteal artery variation in origin, course and branches to reduce the iatrogenic faults.

Keywords: internal pudendal artery, inferior gluteal artery, superior gluteal artery, internal iliac artery. sciatic neuropathy, sciatic nerve

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Authors: Reda Abdel Azim, Tariq Shehab

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The main objective of this study is to develop a subsurface fracture map of naturally fractured reservoirs by overcoming the limitations associated with different data sources in characterising fracture properties. Some of these limitations are overcome by employing a nested neuro-stochastic technique to establish inter-relationship between different data, as conventional well logs, borehole images (FMI), core description, seismic attributes, and etc. and then characterise fracture properties in terms of fracture density and fractal dimension for each data source. Fracture density is an important property of a system of fracture network as it is a measure of the cumulative area of all the fractures in a unit volume of a fracture network system and Fractal dimension is also used to characterize self-similar objects such as fractures. At the wellbore locations, fracture density and fractal dimension can only be estimated for limited sections where FMI data are available. Therefore, artificial intelligence technique is applied to approximate the quantities at locations along the wellbore, where the hard data is not available. It should be noted that Artificial intelligence techniques have proven their effectiveness in this domain of applications.

Keywords: naturally fractured reservoirs, artificial intelligence, fracture intensity, fractal dimension

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Authors: Adrian Sebastian, Chris Gillespie

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We describe a case of diffuse rectal involvement with cap polyposis, manifesting with a protein-losing colopathy and occurring in the setting of advanced mechanical pelvic floor dysfunction. A 59-year-old male with a 5-year history of persistent excessive flatulence, defecatory difficulties, and diarrhea. He had extensive cap polyposis of the entire rectum endoscopically. His symptoms progressed to severe fecal incontinence with mucus leakage, pelvic pain, weight loss, and hypoalbuminemia. Clinical examination exhibited severe perineal descent, a large rectocele, poor anal squeeze, and a poor defecatory technique. After a trial of nonoperative therapies addressing his defecatory dysfunction, and Helicobacter pylori eradication, surgical resection was offered due to severe symptoms with ongoing incontinence and protein loss with no other reasonable options. A robotic abdominoperineal resection with a permanent colostomy was performed, followed by an uncomplicated recovery. Our observation of coexisting mechanical pelvic floor changes in this patient lends weight to the concept of a prolapse-related phenomenon in the pathophysiology of this rare condition.

Keywords: cap polyposis, pelvic dysfunction, fecal incontinence, case report

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Authors: Masoud Nasiri Sarvi, Yunhua Luo

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Low-trauma hip fracture, usually caused by fall from standing height, has become a main source of morbidity and mortality for the elderly. Factors affecting hip fracture include sex, race, age, body weight, height, body mass distribution, etc., and thus, hip fracture risk in fall differs widely from subject to subject. It is therefore necessary to develop a subject-specific biomechanical model to predict hip fracture risk. The objective of this study is to develop a two-level, image-based, subject-specific biomechanical model consisting of a whole-body dynamics model and a proximal-femur finite element (FE) model for more accurately assessing the risk of hip fracture in lateral falls. Required information for constructing the model is extracted from a whole-body and a hip DXA (Dual Energy X-ray Absorptiometry) image of the subject. The proposed model considers all parameters subject-specifically, which will provide a fast, accurate, and non-expensive method for predicting hip fracture risk.

Keywords: bone mineral density, hip fracture risk, impact force, sideways falls

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Authors: Ennouri Triki, Toan Vu-Khanh

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Resistance to combined puncture/cutting by pointed blades is an important property of gloves materials. The purpose of this study is to propose an approach derived from the fracture mechanics theory to calculate the fracture energy associated to the puncture/cutting of nitrile rubber. The proposed approach is also based on the application of a sample pre-strained during the puncture/cutting test in order to remove the contribution of friction. It was validated with two different pointed blade angles of 22.5° and 35°. Results show that the applied total fracture energy corresponding to puncture/cutting is controlled by three energies, one is the fracture energy or the intrinsic strength of the material, the other reflects the friction energy between a pointed blade and the material. For an applied pre-strain energy (or tearing energy) of high value, the friction energy is completely removed. Without friction, the total fracture energy is constant. In that case, the fracture contribution of the tearing energy is marginal. Growth of the crack is thus completely caused by the puncture/cutting by a pointed blade. Finally, results suggest that the value of the fracture energy corresponding to puncture/cutting by pointed blades is obtained at a frictional contribution of zero.

Keywords: elastomer, energy, fracture, friction, pointed blades

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Authors: Iqbal Pramukti, Mamat Lukman, Hasniatisari Harun, Kusman Ibrahim

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Introduction: People living with HIV had a higher risk of osteoporotic fracture than the general population. The purpose of this study was to predict the 10-year risk of fracture among people living with HIV (PLWH) using FRAX™ and to identify characteristics related to the fracture risk. Methodology: This study consisted of 75 subjects. The ten-year probability of major osteoporotic fractures (MOF) and hip fractures was assessed using the FRAX™ algorithm. A cross-tabulation was used to identify the participant’s characteristics related to fracture risk. Results: The overall mean 10-year probability of fracture was 2.4% (1.7) for MOF and 0.4% (0.3) for hip fractures. For MOF score, participants with parents’ hip fracture history, smoking behavior and glucocorticoid use showed a higher MOF score than those who were not (3.1 vs. 2.5; 4.6 vs 2.5; and 3.4 vs 2.5, respectively). For HF score, participants with parents’ hip fracture history, smoking behavior and glucocorticoid use also showed a higher HF score than those who were not (0.5 vs. 0.3; 0.8 vs. 0.3; and 0.5 vs. 0.3, respectively). Conclusions: The 10-year risk of fracture was higher among PLWH with several factors, including the parent’s hip. Fracture history, smoking behavior and glucocorticoid used. Further analysis on determining factors using multivariate regression analysis with a larger sample size is required to confirm the factors associated with the high fracture risk.

Keywords: HIV, PLWH, osteoporotic fractures, hip fractures, 10-year risk of fracture, FRAX

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Authors: Allyson Augusta Shrikhande, Alexa Rains, Tayyaba Ahmed, Marjorie Mamsaang, Rakhi Vyas, Janaki Natarajan, Erika Moody, Christian Reutter, Kimberlee Leishear, Yogita Tailor, Sandra Sandhu-Restaino, Lora Liu, Neha James, Rosemarie Filart

Abstract:

Characterized by consistent difficulty getting and keeping an erection firm enough for intercourse, Erectile Dysfunction may affect up to 15% of adult men. Although awareness and access to treatment have improved in recent years, many patients do not actively seek diagnosis or treatment due to the stigma surrounding this condition. Patients who do seek treatment are often dissatisfied by the efficacy of the medication. The condition inhibits patients’ quality of life by worsening mental health and relationships. The purpose of this study was to test the effectiveness of an outpatient neuromuscular treatment protocol in treating the symptoms of Chronic Pelvic Pain and Erectile Dysfunction, improving pain and function. 56 patients ages 20-79 presented to an outpatient clinic for treatment of pelvic pain and Erectile Dysfunction symptoms. These symptoms had persisted for an average of 4 years. All patients underwent external ultrasound-guided hydro-dissection technique targeted at pelvic peripheral nerves in combination with pelvic floor musculature trigger-point injections. To measure the effects of this treatment, a five question Erectile Dysfunction questionnaire was completed by each patient at their first visit to a clinic and three months after treatment began. Answers were summed for a total score of 5-25, with a higher score indicating optimal function. The average score before treatment was 14.125 (SD 5.411) (a=0.05; CI 12.708-15.542), which increased by 18% to an average of 16.625 (SD 6.423) (a=0.05; CI 14.943-18.307) after treatment (P=0.0004). Secondary outcome variables included a Visual Analogue Scale (VAS) to measure pelvic pain intensity and the Functional Pelvic Pain Scale (FPPS) to measure function across multiple areas. VAS scores reduced by 51% after three months. Before treatment, the mean VAS score was 5.87, and the posttreatment mean VAS score was 2.89. Pelvic pain functionality improved by 34% after three months. Pretreatment FPPS scores averaged at 7.48, decreasing to 4.91 after treatment. These results indicate that this unique treatment was very effective at relieving pain and increasing function for patients with Erectile Dysfunction.

Keywords: chronic pelvic pain, erectile dysfunction, nonsurgical, outpatient, trigger point injections

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

Abstract:

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

Procedia PDF Downloads 757

Authors: Ahmad Nazrun Shuid, Isa Naina Mohamed, Nurul Izzah Ibrahim, Norazlina Mohamed

Abstract:

Studies have shown that oral tocotrienol, a potent vitamin E, promoted fracture healing of osteoporotic bone. In this study, tocotrienol was combined with a polymer carrier (PLGA), and injected to the fracture site. The slow and constant release of tocotrienol particles would promote fracture healing of post-menopausal osteoporosis rat model. Fracture healing was assessed using micro-CT. Twenty-four Sprague-Dawley rats were ovariectomised or sham-operated and the left tibiae were fractured and fixed with plate and screws. The fractures were created at the upper third of the left tibiae. The rats were divided into 3 groups: sham-operated (SO), ovariectomised-control (OVxC) and PLGA-incorporated tocotrienol treatment (OVx + TT) groups. After 4 weeks, the OVx + TT group showed significantly better callus fracture healing than the OVxC group. In conclusion, tocotrienol-incorporated PLGA was able to promote fracture healing of osteoporotic bone.

Keywords: osteoporosis, micro-CT, tocotrienol, PLGA, fracture

Procedia PDF Downloads 668

Authors: Mahdi Fakoor, Seyed Mohammad Navid Ghoreishi

Abstract:

Investigation of fracture of wood components can prevent from catastrophic failures. Created fracture process zone (FPZ) in crack tip vicinity has important effect on failure of cracked composite materials. In this paper, a failure criterion for fracture investigation of cracked wood specimens under mixed mode I/II loading is presented. This criterion is based on maximum strain energy release rate and material nonlinearity in the vicinity of crack tip due to presence of microcracks. Verification of results with available experimental data proves the coincidence of the proposed criterion with the nature of fracture of wood. To simplify the estimation of nonlinear properties of FPZ, a damage factor is also introduced for engineering and application purposes.

Keywords: fracture criterion, mixed mode loading, damage zone, micro cracks

Procedia PDF Downloads 299

Authors: Maria Barbano Acevedo-Gomez, Elena Sonsoles Rodriguez-Lopez, Sofia Olivia Calvo-Moreno, Angel Basas-Garcia, Cristophe Ramirez

Abstract:

Introduction: Urinary incontinence (UI) is defined as the involuntary leakage of urine. In persons who practice sport, its prevalence is 36.1% (95% CI 26.5%-46.8%) and varies as it seems to depend on the intensity of exercise, movements, and impact on the ground. Such high impact sports are likely to generate higher intra-abdominal pressures and leading to pelvic floor muscle weakness. Even though the emphasis of this research is on female athletes, all women should perform pelvic floor muscle exercises as a part of their general physical exercise. Pelvic floor exercises are generally considered the first treatment against urinary incontinence. Objective: The main objective of the present study was to determine the knowledge of the pelvic floor and of the UI in elite athletes and know if they incorporate pelvic floor strengthening in their training. Methods: This was an observational study conducted on 754 elite athletes. After collecting questions about the pelvic floor, UI, and sport-related data, participants completed the questionnaire International Consultation on Incontinence Questionnaire-UI Short-Form (ICIQ-SF). Results: 57.3% of the athletes reflect not having knowledge of their pelvic floor, 48.3% do not know what strengthening exercises are, and around 90% have never practiced them. 78.1% (n=589) of all elite athletes do not include pelvic floor exercises in their training. Of the elite athletes surveyed, 33% had UI according to ICIQ-SF (mean age 23.75 ± 7.74 years). In response to the question 'Do you think you have or have had UI?', Only 9% of the 754 elite athletes admitted they presently had UI, and 13.3% indicated they had had UI at some time. However, 22.7% (n=171) reported they had experienced urine leakage while training. Of the athletes who indicated they did not have UI in the ICIQ-SF, 25.7% stated they did experience urine leakage during training (χ² [1] = 265.56; p < 0.001). Further, 12.3% of the athletes who considered they did not have UI and 60% of those who admitted they had had UI on some occasion stated they had suffered some urine leakage in the past 3 months (χ² [1] = 287.59; p < 0.001). Conclusions: There is a lack of knowledge about UI in sport. Through the use of validated questionnaires, we observed a UI prevalence of 33%, and 22.7% reported they experienced urine leakage while training. These figures contrast with only 9% of athletes who reported they had or had in the past had UI. This discrepancy could reflect the great lack of knowledge about UI in sports and that sometimes an athlete may consider that urine leakage is normal and a consequence of the demands of training. These data support the idea that coaches, physiotherapists, and other professionals involved in maximizing the performance of athletes should include pelvic floor muscle exercises in their training programs. Measures such as this could help to prevent UI during training and could be a starting point for future studies designed to develop adequate prevention and treatment strategies for this embarrassing problem affecting young athletes, both male and female.

Keywords: athletes, pelvic floor, performance, prevalence, sport, training, urinary incontinence

Procedia PDF Downloads 127

Authors: Tao Yang, Yongli Zhao

Abstract:

Low-temperature cracking is one of the major challenges for asphalt pavement in the cold region. Fracture energy could determine from various test methods, which is a commonly used parameter to evaluate the low-temperature cracking resistance of asphalt mixture. However, the feasibility of evaluating the low-temperature cracking performance of asphalt mixture using fracture energy is not investigated comprehensively. This paper aims to verify whether fracture energy is an appropriate parameter to evaluate the low-temperature cracking performance. To achieve this goal, this paper compared the test results of thermal stress restrained specimen test (TSRST) and semi-circular bending test (SCB) of asphalt mixture with different types of aggregate, TSRST and indirect tensile test (IDT) of asphalt mixture with different additives, and single-edge notched beam test (SENB) and TSRST of asphalt mixture with different asphalt. Finally, the correlation between in-suit cracking performance and fracture energy was surveyed. The experimental results showed the evaluation result of critical cracking temperature and fracture energy are not always consistent; the in-suit cracking performance is also not correlated well with fracture energy. These results indicated that it is not feasible to evaluate low-temperature performance by fracture energy. Then, the composition of fracture energy of TSRST, SCB, disk-shaped compact tension test (DCT), three-point bending test (3PB) and IDT was analyzed. The result showed: the area of thermal stress versus temperature curve is the multiple of fracture energy and could be used to represent fracture energy of TSRST, as the multiple is nearly equal among different asphalt mixtures for a specific specimen; the fracture energy, determined from TSRST, SCB, DCT, 3PB, SENB and IDT, is mainly the surface energy that forms the fracture face; fracture energy is inappropriate to evaluate the low-temperature cracking performance of asphalt mixture, as the relaxation/viscous performance is not considered; if the fracture energy was used, it is recommended to combine this parameter with an index characterizing the relaxation or creep performance of asphalt mixture.

Keywords: asphalt pavement, cold region, critical cracking temperature, fracture energy, low-temperature cracking

Procedia PDF Downloads 190

Authors: Xi Yang, Bulent Chavdar, Alan Vonseggern, Taylan Altan

Abstract:

Fracture in hot precision forging of engine valves was investigated in this paper. The entire valve forging procedure was described and the possible cause of the fracture was proposed. Finite Element simulation was conducted for the forging process, with commercial Finite Element code DEFORMTM. The effects of material properties, the effect of strain rate and temperature were considered in the FE simulation. Two fracture criteria were discussed and compared, based on the accuracy and reliability of the FE simulation results. The selected criterion predicted the fracture location and shows the trend of damage increasing with good accuracy, which matches the experimental observation. Additional modification of the punch shapes was proposed to further reduce the tendency of fracture in forging. Finite Element comparison shows a great potential of such application in the mass production.

Keywords: hotforging, engine valve, fracture, tooling

Procedia PDF Downloads 280