Complex fracture

Magnesium (Mg) medical devices are currently being marketed for orthopedic applications and have a complex degradation process which includes the evolution of hydrogen gas (H2 ). The effect of H2 exposure on relevant cell types has not been studied; and the concentration surrounding degrading Mg devices has not been quantified to enable such mechanistic studies. A simple and effective method to measure the concentration of H2 in varying microenvironments surrounding Mg implants is the first step to understanding the biological impact of H2 on these cells...

Distal limb fracture is the most common cause of complex regional pain syndrome (CRPS), thus the rodent tibia fracture model (TFM) was developed to study CRPS pathogenesis. This comprehensive review summarizes the published TFM research and compares these experimental results with the CRPS literature. The TFM generated spontaneous and evoked pain behaviors, inflammatory symptoms (edema, warmth) and trophic changes (skin thickening, osteoporosis) resembling symptoms in early CRPS. Neuropeptides, inflammatory cytokines, and nerve growth factor (NGF) have been linked to pain behaviors, inflammation, and trophic changes in the TFM model and proliferating keratinocytes were identified as the primary source of cutaneous cytokines and NGF...

Background: Implementation of an inclusive trauma system leads to reduced mortality rates, specifically in polytrauma patients. Field triage is essential in this mortality reduction. Triage systems are developed to identify patients with life-threatening injuries, and trauma mechanisms are important for triaging. Although complex extremity fractures are mostly non-lethal, these injuries are frequently the result of a high-energy trauma mechanism. The aim of this study is to compare injury and patient characteristics, as well as resource demands, of lower extremity fractures between a level (L)1 and level (L)2 trauma centre in a mature inclusive trauma system...

We evaluated the accuracy of the predictive injury sequences of the Lauge-Hansen (L-H) classification using magnetic resonance imaging (MRI) in patients with ankle fractures and determined the possible causes of mismatch. Sixty-five patients with ankle fractures who had a complete series of anteroposterior, lateral, and oblique radiographs and ankle MRI studies available were included. The fracture pattern was assigned by 2 senior orthopedic surgeons according to the L-H classification system. The syndesmotic ligaments, lateral collateral ligaments, and medial deltoid complex ligaments were evaluated on the preoperative MRI scans...

The process of extracting hydrocarbon resources by hydraulic fracturing is an increasingly utilised technique worldwide, resulting in an effluent called flowback and produced water (FPW). This effluent is a complex mixture of salts, metals and organic compounds, and has been shown to be highly toxic to aquatic biota, an effect attributed mainly to its salt and organic components. However, in the current study we show that the water flea, Daphnia magna, is physically impaired by, and rendered immobile at the surface of, test waters containing FPW...

BACKGROUND: Recently, there has been growing interest in the involvement of the posterior bundle of the medial ulnar collateral ligament (pMUCL) in varus posteromedial rotatory instability (PMRI). Varus PMRI has been observed clinically, but the degree of involvement of the pMUCL remains unclear. This study assessed the degree to which the pMUCL is involved in stabilizing the elbow and the feasibility of a pMUCL reconstruction to restore stability. METHODS: Movements simulating PMRI were performed in 8 cadaveric elbows...

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Crown-root fracture is one of the most challenging fracture types in the dental traumatology literature. Traumatized anterior teeth require quick functional and esthetic repair. In the case of a complex crown fracture of the maxillary left central incisor, requiring endodontic treatment, a fiber-reinforced post was used to create a central support stump to restore the dental morphology. This report describes the clinical procedures involved in the treatment. After two years of follow-up, the clinical and radiographic findings demonstrated that the adopted clinical protocol was successful and yielded healthy periodontal tissues with no signs of periradicular pathology...

Purpose  Metaphyseal bone defects are a challenge in complex primary and revision total knee arthroplasty (TKA). Recently, several studies have been published with promising results about the use of Trabecular Metal (TM) cones to address bone defects. The aim of this study is to review the literature to assess the efficacy of TM cones to address metaphyseal bone loss. Methods  A comprehensive search was performed on PubMed, Medline, CINAHL, Cochrane, Embase, and Google Scholar databases using various combinations of the following keywords: "metaphyseal," "cones," "tantalum," "knee," and "revision...

BACKGROUND: Promising results of initial clinical trials with yttria-stabilized zirconia have led to more extensive use of zirconia in dental implant superstructures. The applications have extended to abutments and complex individually designed crown-abutment one-piece structures. Little is known about their clinical success and the primary cause of failures. PURPOSE: The aim of this study was to identify the cause of fracture of retrieved implant-retained one-piece prostheses that failed during clinical use...

Modeling physical phenomena through computational simulation increasingly relies on generating a collection of related runs, known as an ensemble. This article explores the challenges we face in developing analysis and visualization systems for large and complex ensemble data sets, which we seek to understand without having to view the results of every simulation run. Implementing approaches and ideas developed in response to this goal, we demonstrate the analysis of a 15K run material fracturing study using Slycat, our ensemble analysis system...

INTRODUCTION: Revision knee arthroplasty is increasing, and in that case, bone loss management is still a challenging problem. In the last years, the body of literature and interest surrounding porous metal cones has grown, but few systematic evaluations of the existing evidence have been performed. The aim of our systematic review is to collect and critically analyze the available evidence about metal cones in revision knee arthroplasty especially focusing our attention on indications, results, complications, and infection rate of these promising orthopaedic devices...

Unstable fracture-dislocations of the elbow, and in particular the "terrible triad" injury consisting of an elbow dislocation with a fracture of the radial head and coronoid, are complex injuries that can be plagued and complicated by persistent instability. Acute and chronic instability is a difficult problem and is best managed early by avoidance and restoration of stability. A number of treatment options have been proposed to manage acute postfixation instability of the elbow joint. Traditional stabilization options include immobilization with splinting or casting, cross-articular pinning, and external fixation (hinged or static), followed by early physical therapy...

Fracture healing is a complex process of many coordinated biological pathways. This system can go awry resulting in nonunion, which leads to significant patient morbidity. The Hedgehog (Hh) signaling pathway is upregulated in fracture healing. We hypothesized that the Hh signaling pathway can be pharmacologically modulated to positively affect fracture healing. Diaphyseal femur fractures were created in elderly mice (18 months, C57BL/6 females), which have a blunted and delayed healing response compared to younger mice, and were stabilized with intramedullary pins...

Despite the high prevalence of osteoporosis in chronic obstructive pulmonary disease (COPD) patients, the fracture risk prediction tools are not routinely undertaken in the management of COPD. We quantified fracture risk using a validated risk prediction tool (Fracture Risk Assessment (FRAX®)) and determined potential bone-protection treatment needs in patients with advanced COPD. The 10-year probability of major osteoporotic or hip fracture was calculated using the FRAX tool in a cohort of patients attending a hospital complex COPD service...

To assess the risk of underground sources of drinking water contamination by barium (Ba) present in petroleum produced water disposed into deep saline aquifers, we examined the effect of salinity (NaCl), competition of cations (Ca, Mg), temperature (22 and 60°C), and organic fracturing additives (guar gum) on the sorption and transport of Ba in dolomites and sandstones. We found that at typical concentration levels of NaCl, Ca, and Mg in petroleum produced water, Ba sorption in both dolomites and sandstones is inhibited by the formation of Ba(Cl)+ complexes in solution and/or the competition of cations for binding sites of minerals...

Biomaterial composites made of titanium and hydroxyapatite (HA) powder are among the most important biomedicalmaterials due to their good mechanical properties and biocompatibility. In this work, graphene-reinforced titanium matrix/nano-hydroxyapatite nanocomposites were prepared by vacuum hot-pressing sintering. The microstructure and mechanical properties of graphene-reinforced titanium matrix/nano-hydroxyapatite nanocomposites with different graphene content were systematically investigated. Microstructures of the nanocomposites were examined by X-ray diffraction (XRD), back scattered electron imaging (BSE), scanning electron microscope (SEM) equipped with energy dispersive spectrometer (EDS), electron probe microanalyzer (EPMA), and transmission electron microscope (TEM)...

BACKGROUND: Currently, there is a relative paucity of data investigating the operative management of displaced pediatric zygomaticomaxillary complex (ZMC) fractures. The purpose of this study was to assess ZMC fracture management and associated complications in the pediatric population, and potentially describe a standard treatment paradigm for pediatric ZMC fractures. METHODS: A retrospective cohort review was performed of all patients younger than 15 years-of-age presenting to a single institution with ZMC fractures from 1990-2010...

PURPOSE: The aim of this study was to determine the effect of bone mineral density (BMD) on the stress distribution in pelvic-hip complex (PHC) model which included bone structures and soft tissues. Bone mass changes in osteoporosis and osteopenia were considered in this analysis. In addition, the relations between force direction and stress distribution causing PHC fractures were determined. METHODS: This paper presents the development and validation of a detailed 3D finite element model with high anatomical fidelity of the PHC and BMD changes in trabecular and cortical bones, modelled based on CT scans...

OBJECTIVE: There is lack of consensus on the preferred approach for unstable Hangman's fracture. The associated soft tissue injuries apart from apparent bony injury add to the complexity of dislocation and needs to be addressed. Here, we evaluated the clinico-radiological characteristics and outcome of patients managed by posterior C2-3 fusion. PATIENTS & METHODS: Nine patients with unstable Hangman's fracture (type II and IIA) were prospectively studied. The displacement of fractured fragments and C2-3 dislocation was studied in multiple planes...