Background: Ankle fractures, comprising about 10% of musculoskeletal injuries, pose a significant healthcare burden with an increasing incidence, particularly among an aging population. This study focuses on isolated Danis-Weber type B fractures. Recent trends lean towards surgical intervention for anatomical restoration, quicker recovery, albeit with associated complications. This report aims to assess the safety and efficacy of NewClip narrow locking plate system with early weight bearing in treating isolated fibular fractures. Methods: The study includes patients with Danis-Weber type B fractures surgically treated with NewClip narrow locking plate system. Exclusions involved nondisplaced fractures, open fractures, or those requiring additional fixation.Results: Fifteen patients were enrolled in this study. Minor complications, including wound swelling, were observed in two cases. The Visual Analogue Scale (VAS) for pain exhibited a steady decline postoperatively, with almost complete resolution by the third month. At three months, the FAOS demonstrated excellent results, and final follow-up at twelve months revealed complete osseous healing without complications.Conclusions: The use of this type of plates in treating isolated fibular fractures with early weight bearing shows promising results in terms of fracture healing, pain resolution, and functional outcomes warranting further investigation with larger cohorts.

Abstract: Panfacial fractures are complex injuries involving multiple regions of the facial skele-ton simultaneously, which may necessitate multiple surgeries over a relatively short period. They are often associated with polytrauma and other injuries including brain trauma, which re-quire either immediate airway management, prolonged intubation, or repeated intubations for staged surgeries. Given the frequent need for intermaxillary fixation and the potential involve-ment of the central nasal complex or skull base, conventional oro-tracheal or nasotracheal intu-bation often presents challenges. Submental intubation is the most reported method of airway management with the aim to avoid tracheostomy and its related complications. A review of the different techniques of airway management in the elective treatment of panfacial fractures was performed focusing on the advantages and disadvantages of each method. Most of the literature consisted of retrospective studies, with only one prospective study comparing submental intu-bation to tracheostomy in panfacial fractures. There is abundant literature that favours the sub-mental intubation for its rapid establishment and low complication rate. Other techniques less reported were retromolar intubation, nasotracheal to orotracheal switch, tracheostomy or crico-thyroidotomy. An algorithm for the management of the airway in panfacial fractures is pre-sented.

This study aimed to demonstrate the potential role of Dual Energy CT in assessing Bone Mineral Density (BMD) in postmenopausal women. A retrospective study was conducted on 51 postmenopausal female patients who underwent DXA and DECT examinations for other clinical reasons. DECT images were acquired with spectral imaging using a 256-slice system. These images were processed and visualized using an HAP(fat) map. Statistical analysis was performed using the Bland-Altman method to assess agreement between DXA and DECT HAP(fat) measurements. Mean BMD, vertebral and femoral T-scores were obtained. For vertebral analysis, the Bland-Altman plot showed an inverse correlation (R2: -0.042; RMSE: 0.690) between T-scores and DECT HAP(fat) values for measurements from L1 to L4, while a good linear correlation (R2: 0.341; RMSE: 0.589) it was found for measurements at the femoral neck. In conclusion, we demonstrated the enhanced accuracy of BMD calculation through DECT, finding a statistically significant correlation only at the femoral neck where BMD results do not seem to be influenced by the overlap of the measurements on cortical and trabecular bone. This outcome could be beneficial in the future by reducing radiation exposure for patients already undergoing follow-up for chronic conditions.

Background/Objectives: Concurrent opioid (OPI) and benzodiazepine (BZD) use may exacerbate falls/fractures risk compared to no use or use alone. Yet, patients may need concurrent OPI-BZD use for co-occurring conditions (e.g., pain and anxiety). Therefore, we examined the association between longitudinal OPI-BZD dosing patterns and subsequent injurious falls risk. Methods: We conducted a retrospective cohort study including non-cancer fee-for-service Medicare beneficiaries initiating OPI and/or BZD in 2016-2018. We identified OPI-BZD use patterns during the 3 months following OPI and/or BZD initiation (i.e., trajectory period) using group-based multi-trajectory models. We estimated time to first injurious fall within 3 months post-trajectory period using inverse-probability-of-treatment-weighted Cox proportional hazards models. Results: Among 622,588 beneficiaries (age≥65=84.6%, female=58.1%, White=82.7%; having injurious falls=0.45%), we identified 13 distinct OPI-BZD trajectories: Group(A):Very-low OPI-only (early discontinuation)(44.9% of the cohort); (B):Low OPI-only (rapid decline)(15.1%); (C):Very-low OPI-only (late discontinuation)(7.7%); (D):Low OPI-only (gradual decline)(4.0%); (E):Moderate OPI-only (rapid decline)(2.3%); (F):Very-low BZD-only (late discontinuation)(11.5%); (G):Low BZD-only (rapid decline)(4.5%); (H):Low BZD-only (stable) (3.1%); (I):Moderate BZD-only (gradual decline)(2.1%); (J):Very-low OPI (rapid decline)/Very-low BZD (late discontinuation)(2.9%); (K):Very-low OPI (rapid decline)/Very-low BZD (increasing)(0.9%); (L):Very-low OPI (stable)/Low BZD (stable)(0.6%); and (M):Low OPI (gradual decline)/Low BZD (gradual decline)(0.6%). Compared with Group(A), 6 trajectories had increased 3-month injurious fall risks: (C): HR, 95%CI=1.78, 1.58-2.01; (D): 2.24, 1.93-2.59; (E): 2.60, 2.18-3.09; (H): 2.02, 1.70-2.40; (L): 2.73, 1.98-3.76; and (M): 1.96, 1.32-2.91. Conclusions: Our findings suggest that 3-month injurious fall risk varied across OPI-BZD trajectories, highlighting the importance of considering both dose and duration when assessing fall risks of OPI-BZD use among older adults.

Fractures are present in hydrocarbon reservoirs of different porosity ranges. Seismic anisotropy has been widely used in fracture characterization and shown to be sensitive to background matrix porosities in theoretical studies. An understanding of the effects of background porosity on seismic anisotropy could improve seismic characterization in different fractured reservoirs. Based on synthetic rocks with controlled fractures, we conducted laboratory experiments to investigate the influence background porosity has on P wave anisotropy and shear wave splitting. A set of rocks containing the same fracture density (0.06) with varying porosities of 15.3%, 22.1%, and 30.8% were constructed. P and S wave velocities were measured at 0.5 MHz as rocks were water saturated. Results show that when porosity increased from 15.3% to 22.1%, P wave anisotropy and shear wave splitting exhibit slight fluctuations. However, when porosity continued to increase to 30.8%, P wave anisotropy declined sharply while shear wave splitting stayed nearly constant. The measured results were compared with predictions from equivalent medium theories. Qualitative agreements were found between theoretical predictions and measured results. In Eshelby-Cheng model, the increase of porosity reduces the fracture-induced perturbation in the fracture normal direction, resulting in a lower P wave anisotropy. In Gurevich(2003) model, the increase of porosity can reduce the compressional stiffness in parallel direction to a larger extent than that in perpendicular direction, thus leading to lower P wave anisotropy.

A low calcium intake is associated with an increased fracture risk. We assessed the dietary calcium intake in a cohort of Italian individuals evaluated for low bone mineral density (BMD). A 7-day food-frequency questionnaire was administered to 1793 individuals consecutively referred at a Centre of the Italian Society for Osteoporosis, Mineral Metabolism and Skeletal Diseases for low BMD. In 30.3% (544/1793) and 20.9% (374/1793) of subjects the calcium intake was inadequate ( <700 mg/day) and adequate (>1200 mg/day), respectively. Patients with calcium intake <700 mg/day showed a higher prevalence of diabetes mellitus, idiopathic hypercalciuria and food allergy/intolerance (8.1%, 5.1%, 7.2%, respectively) than patients with calcium intake >700 mg/day (5.3%, 3.0%, 4.1%, respectively, p<0.04 for all comparisons), also after adjusting for age, gender and BMI. In 30.3% of fractured subjects the calcium intake was <700 mg/day. In Italy, a low calcium intake is highly prevalent in individuals at risk for low BMD. Importantly, an inadequate calcium intake is highly prevalent even in patients with history of fragility fractures. Only about a fifth of patients at risk for low BMD reported an adequate calcium intake

Study design: Retrospective cohort study. Objectives: To investigate the outcomes of early ballon kyphoplasty (BKP) intervention compared with late intervention for osteoporotic vertebral fracture. Background: Osteoporotic vertebral fractures, can lead to kyphotic deformity, severe back pain, depression, and disturbances in activities of daily living (ADL). BKP has been widely utilized to treat symptomatic OVFs and has proven to be a very effective surgical option for this condition. BKP is relatively a safe and effective method due to less acrylic cement leakage and greater kyphosis correction. Materials and Methods: A retrospective comparative study was conducted at our hospital for patients who underwent BKP for osteoporotic vertebral fractures in the time frame between January 2020 and December 2022. Ninety-nine patients were included in this study, patients were classified into two groups: 36 patients underwent early BKP intervention (EI)

(1) Background: Proximal humerus fractures can be a debilitating condition if not properly treated. These fracture patterns are varied and differ in every patient. Functional outcomes may be determined by the integrity of the shoulder girdle involving the rotator cuff insertion. The post-operative resorption or malreduction of the greater tuberosity is an important factor contributing to the poor functional outcome of a patient. (2) Methods: A single-center retrospective comparative study was performed to evaluate the functional outcomes of patients undergoing operative fixation for this injury. A total of 387 consecutive cases treated operatively from 2019-2021 were included for analysis. (3) Results: 94 cases fulfilled our criteria for analysis. A matched-group comparison of 19 patients each was performed to compare demographics, post-operative fracture characteristics and functional outcomes. (4) Conclusions: The resorption or malreduction of the greater tuberosity contributes greatly to the prognostic outcome in patients treated with ORIF surgery. In our demographic study, obesity is another contributing factor affecting the parameters of post-operative reduction in proximal humerus fractures. Appropriate surgical planning and post-operative multidisciplinary care must be taken into consideration to attain a satisfactory prognostic outcome.

We propose a new statistical analysis of the Acoustic Emissions (AE) produced in a series of triaxial deformation experiments leading to fractures and failure of two different rocks, namely, Darley Dale Sandstone (DDS) and AG Granite (AG). By means of q-statistical formalism, we are able to characterize the pre-failure processes in both types of rocks. In particular, we study AE inter-event time and AE inter-event distance distributions. Both of them can be reproduced with q-exponential curves, showing universal features which are observed here for the first time and could be important in order to understand more in detail rock fractures dynamics.

An alleged association of chronic use of thiazide diuretics with an increased risk of bone fragility fractures has been highlighted by a relatively recent prospective cohort study (Am J Med. 2016 Dec; 129(12):1299-1306). However, the concept that thiazides exert a beneficial effect on osteoporosis is still a predominant view. This effect would be mediated by the decrease in renal clearance of calcium ions, a pharmacological feature recognized for a long time now to this class of drugs , as opposed to the increase in calcium urinary excretion attributed instead to loop diuretics, i.e. furosemide and similar drugs . The purpose of this retrospective study is to attempt to clarify whether regular use of thiazide diuretics as antihypertensive therapeutics is associated with a significantly increased risk of osteoporotic fractures in female patients, aged over 70 years.

Background: due to increase in total hip arthroplasties (THAs), the incidence of periprosthetic hip fractures (PPHFs) is forecast to raise considerably in the next decades, with Vancouver B1 fractures (VB1) accounting for one third of total cases. Femur fixation with cerclages (with or without screws) is considered the current treatment option for intraoperative VB1. Methods: the study retrospectively includes data from patients who developed VB1 PPHFs during THAs from December 3rd 2020 to November 30th 2022. The primary outcome of this study was to identify the reintervention-free survival rate. The secondary aim was to determine clinical and radiographic assessment at follow-up, based on Harris hip score (HHS) and limb length discrepancy (LLD). Results: 37 patients with mean age 60.03 ± 15.49 (22 to 77) years old were included. Overall, the Kaplan-Meier estimated a re-operation free survival rate of 99% (CI 95%) at 6 months. The mean limb length discrepancy (LLD) improved from -3.69±6.07 (range -27.9 to 2.08) mm to 0.10±0.67 (range -1.07 to 1.20) mm. The mean HHS improved from 42.72±14.37 (range 21.00-96.00) to 94.40±10.32 (range 56.00-100.00).

Intramedullary fixation with elastic stable intramedullary nailing and stabilization with an external fixator are standard methods for the treatment of diaphyseal femoral shaft fractures in children. A retrospective bi-centre cohort study was carried out, including all patients between the ages of 2 and 16 years with isolated traumatic diaphyseal femur fractures, treated either with intramedullary nailing or an external fixator. In total, 57 patients (17 female and 40 male) with a mean age of 6.5 ± 2.7 years (min. 2; max. 16 years) with a mean follow-up period of 6.1 ± 4.6 months (min. 2; max. 26 months), were included in this retrospective study. 33 patients were treated with elastic stable intramedullary nailing and 24 patients, and external fixation. In total, 18 patients (32%) experienced osteosynthesis-related complications: 8 patients (24%) in the elastic stable intramedullary nailing group and 10 (42%) in the external fixation group, leading to revision surgery in 10 patients (18%). At the latest follow-up, all fractures were radiologically healed with no evidence of malangulation or malrotation (defined as &gt;20°) and full weight-bearing. There was a lower rate of complications in the ESIN group than in the external fixation group. Overall, we were unable to show a significant difference between the two methods.

Abstract: Comparing outcrop data to laboratory results is important to verify and validate experiments of analogue and reservoir materials especially regarding conditions for deformation experiments. This is important better understand highly complex carbonate reservoir strata and their response to changes in subsurface conditions, reducing subsurface uncertainty. This study develops methods to allow for a more straightforward comparison of outcrop data (m-scale) with experimentally created fracture arrays developed in cylindrical samples (cm-scale). The main objective is to assess usefulness of experimentally-produced fracture networks as analogues for subsurface structures, typically at the meter and above scale by developing new techniques to use the lab deformation. It analyses key characteristics of laboratory-induced fracture networks by adapting scanline methods to use with x-ray tomography (XRT) images to allow for comparison with outcrop and field data. To test and verify these new methods two low permeability carbonate samples were used for deformation testing and analysis. Applying the different scanline methods we show that they can be used to analyse lab induced fractures (mm to cm-scale) identified in XRT images for comparison with outcrop data (m-scale). In addition, these methods also allow for quantification of fracture network attributes e.g. fracture spacing, fracture apertures, orientation. This new data bridges the gap between micro-scanlines using thin sections and outcrop scanlines.

Background: By 2025, road traffic injuries are projected to rank third in the global burden of disease, posing a significant challenge that affects health, social well-being, and economic aspects. According to data from the Romanian Police National Statistics Center, there has been an average of 342 traffic accidents per year involving pediatric patients over the past 10 years. Materials and Methods: A retrospective research study was conducted, encompassing 358 cases of road traffic accidents identified for the study. Data collection was conducted at "St. Mary’s" Emergency Hospital for Children in Iasi, Romania, from January 2015 to December 2022. To facilitate statistical analyses, participants were categorized into three specific age groups, correlating between the anatomical region affected and different types of accidents was examined, and the classification of injury types was determined based on the characteristics of the harm inflicted. Results: An oscillating trend is observed from 2015 to 2020, with its lowest value recorded in 2017 at around 6.8% and its peak in 2019 at 20.1%. Notably, post-pandemic (Covid-19), the cases underwent a substantial decline of approximately 50%. At least 78.7% of those who did not undergo orthopedic reduction required surgery, whereas among those who underwent orthopedic reduction, only 23.4% needed surgery. Regarding the frequency of complications 7,9% of the total cases experienced complications. Conclusion: The increased frequency of pediatric traffic accidents is attributed to the extensive services provided by "St. Mary’s" Emergency Hospital for Children, Iasi, to a significant number of patients from both rural and urban areas across the seven counties of the Moldova, Romania.

Shape of supracondylar fracture of the humeral of pediatric patients is analysed with Procrustes method. XR–images of fractures are considered both in anterio-posterior (AP) view (66 images) and in a lateral (L) view (24 images). Applying Procrustes method for both views mean images are constructed and compared. Variability of shapes is quantified with a shape principal component analysis. Non-parametric tests (permutational and bootstrap) do not indicate statistical difference between Procrustes mean shapes in anterio-posterior and lateral projections. It is shown, however, that AP and L shapes of humeral fractures differ in their variability quantified by shape principal components.

CO₂ geological storage in deep saline aquifers was recently developed at industrial scale mainly in sandstone formations. Experiences on CO₂ injections in carbonates aquifers for permanent trapping are quite limited, mostly from US projects such as AEP Mountaineer, Michigan and Williston Basin. The behavior of fractures in carbonates plays a key role in those reservoirs in which porous matrix permeability is very poor, which drives the CO₂ plume migration through the fracture network where hydromechanics and geochemical effects take place due to injection. Hontomín (Spain) is the actual on-shore injection pilot in Europe (EP Resolution of 14 January 2014), whose reservoir is comprised of fractured carbonates. Existing experiences from field scale tests conducted on site have supported to better understand the behavior of this type of reservoirs for CO₂ geological storage. Innovative CO₂ injection strategies are being carried out in ENOS Project (EU H2020 Programme, http://www.enos-project.eu). First results based on field tests conducted at Hontomín, and the advanced modelling developed so far will be analyzed and discussed in this article, as well as, the description of future works. The evolution of operating parameters such as flow rate, pressure and recovery term during the tests confirm the CO₂ migration through the fractures.

Post-menopausal women are at risk of osteoporotic vertebral fractures (OVFs), which if undetected and untreated, can lead to significant pain and morbidity. However, OVFs are often not reported by radiologists on routine chest radiographs. Artificial Intelligence (AI) is increasingly used in medical applications with improvements in detection and diagnosis. This study aims to investigate the clinical value of a newly developed AI tool, Ofeye 1.0 for automated detection of OVFs on lateral chest radiographs in post-menopausal women (&gt;60 years) who were referred to undergo chest x-rays for other reasons. A total of 510 de-identified lateral chest radiographs from three clinical sites were retrieved and analysed by Ofeye1.0 tool. These images were then reviewed by a consultant radiologist to decide whether there is any fracture present or not with findings served as the reference standard for determining the diagnostic performance of the AI tool. The percentage of radiologist reports which included the OVF was analysed by comparing diagnostic reports with AI findings, while the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) of the AI tool were calculated. Out of all the original radiologist reports, missed OVFs were found in 14% images but were detected by the AI tool. The AI tool demonstrated a relatively high specificity 92.8% (95% CI: 89.6, 95.2%), moderate accuracy 80.3% (95% CI: 76,3, 80.4%), PPV 73.7% (95% CI: 65.2, 80.8%) and NPV 81.5% (95%CI: 79, 83.8%), but low sensitivity 49% (95%CI: 40.7, 57.3%). The high false negative results were mainly due to mild OVFs with &lt;20% vertebral height loss. The new AI software tool has high specificity with a low false positive rate of 5.1%, showing that it can be used as a complimentary tool to the routine diagnostic reports for reduction of missed OVF in elderly women. The low sensitivity with high false negative rates indicate the necessity of radiologist’s in identifying and reporting early OVFs.

Patients with non-union fractures spend extended periods in the hospital following poor healing. Patients have to make several follow-up visits for medical and rehabilitation purposes. However, the clinical pathways and quality of life of these patients are unknown. This prospective study aimed to identify the clinical pathways (CPs) of 22 patients with lower limb non-union fractures whilst determining their quality of life. Data were collected from hospital records on admission through discharge, utilising a CP questionnaire. We used the same questionnaire to track patients' follow-up frequency, involvement in activities of daily living, and outcomes at six months. We used the short form-36 questionnaire to assess patients’ initial quality of life. The Kruskal-Wallis test compared the quality of life domains across different fracture sites. We examined CPs using medians and inter-quantile ranges. During the six-month follow-up period, 12 patients with lower limb non-union fractures were readmitted. All of the patients had impairments, limited activity, and participation restrictions. Lower limb fractures can have a substantial impact on emotional and physical health, and lower limb non-union fractures may have an even greater effect on the emotional and physical health of patients, necessitating a more holistic approach to patient care.

Results of geological and geophysical investigations of the Siljan Ring impact structure (central Sweden) revealed complicated relationships between Paleozoic sedimentary succession and the Precambrian basement. Tectonic and depositional evolution caused complex geology. Studies of a new drill core from the C-C-1 well provide information necessary for the reconstruction of the geological setting in the southwestern part of Siljan Ring. The whole interval of the core section is from 32.60 to 634.90 m with almost no breaks. The sedimentary cover is 373.55 m thick in total. The sedimentary sequences are predominantly composed of wackestones, mudstones, and shales. In the lower part of the sedimentary section, limestone layers intercalate with black shales. In a result of the investigations, it has been suggested that sedimentary layers represent Late Ordovician and Silurian deposits and have disturbed stratigraphic relations. The basement section is composed of Precambrian meta-volcanic and meta-sedimentary rocks. The contact between the basement and the sedimentary cover is tectonic, not normal sedimentary, in origin. Tectonic processes caused intensive rock fracturing. Four generations of fractures were identified with analysis of fracture relations and mineralization sequence. Only two of them occur in sedimentary rocks that probably belong to the latest stages of tectonic activity. Highly fractured basement rocks in some cases contain open vugs developed along the fractures. Rock matrix is tight either in sedimentary and basement rocks and only micro-porosity space is recognized in cataclastic zones. Single evidence of bituminous filling of micro-porosity zone and partly cemented vug is established in limestone from the lower part of the sedimentary section. These findings are particularly valuable for stratigraphy refinement and tectonic setting reconstructions as well as oil and gas reservoir forecasts.

Background: Tibial shaft fractures are the most common of long bone fractures. The gold standard for management is locked intramedullary nailing. The freehand method under fluoroscopic monitoring is the most often utilized method for distal screw locking. Electromagnetic guidance-based distal screw locking methods have gained popularity recently. The study's objective is to evaluate the system using electromagnetic tracking data against the free-hand technique. Methods: Sixty-three patients who received intramedullary nailing for tibial shaft fractures at our institute between January 2018 and May 2022, were included in this study. Two groups of patients were distinguished: Group FH underwent freehand distal locking and intramedullary nailing, while Group SS underwent electromagnetically guided locking. Radiation exposure period, as well as dose area product, were noted and statistically compared. Results: In terms of dose area product, a mean value of 43.57±31.57 cGy/cm2 in group FH and a mean value of 27.62±11.20 cGy/cm2 in group SS (p &lt; 0.05) was assessed. Concerning the duration of surgery a mean value of 128.83±26.51 minutes was reported in group FH and a mean value of 126.42±48.31 minutes in group SS (p &gt; 0.05). Conclusions: This study confirms the use of electromagnetic-guided locking distal screws reduces the total time of exposure to ionizing radiation, with no difference in operating time.

Many studies of hypervelocity impact craters have described the characteristics of quartz grains shock-metamorphosed at high pressures of > 10 GPa. In contrast, few studies have investigated shock metamorphism at lower shock pressures. In this study, we test the hypothesis that low-pressure shock metamorphism occurs in near-surface nuclear airbursts and that this process shares essential characteristics with crater-forming impact events. To investigate low-grade shock microstructures, we compared quartz grains from Meteor Crater, a 1.2-km-wide impact crater, to those from near-surface nuclear airbursts at the Alamogordo Bombing Range, New Mexico in 1945 and Kazakhstan in 1949/1953. This investigation utilized a comprehensive analytical suite of high-resolution techniques, including transmission electron microscopy (TEM) and electron backscatter diffraction (EBSD). Meteor Crater and the nuclear test sites all exhibit quartz grains with closely-spaced, sub-micron-wide fractures that appear to have formed at low shock pressures. Significantly, these micro-fractures are closely associated with Dauphiné twins and are filled with amorphous silica (glass), widely considered a classic indicator of shock metamorphism. Thus, this study confirms that glass-filled shock fractures in quartz form during near-surface nuclear airbursts, as well as crater-forming impact events, and by extension, it suggests that they may form in any near-surface cosmic airbursts in which the shockwave is coupled to Earth’s surface. The robust characterization of such events is crucial because of their potential catastrophic effects on the Earth’s environmental and biotic systems.

Many studies of hypervelocity impact craters have described the characteristics of quartz grains shock-metamorphosed at high pressures of >10 GPa, but in contrast, few studies have investigated shock metamorphism at lower shock pressures. In this study, we test the hypothesis that low-pressure shock metamorphism occurs in near-surface nuclear airbursts and that this process shares important characteristics with impact-cratering events. To investigate low-grade shock microstructures, we compared quartz grains from Meteor Crater, a 1.2-km-wide impact crater, to those from near-surface nuclear airbursts at the Alamogordo Bombing Range, New Mexico in 1945 and Kazakhstan in 1949/1953. This investigation utilized a comprehensive analytical suite of high-resolution techniques, including transmission electron microscopy (TEM) and electron backscatter diffraction (EBSD). Meteor Crater and the nuclear test sites all exhibit metamorphosed quartz grains with closely-spaced, sub-micron-wide fractures that appear to have formed at low shock pressures. Importantly, these micro-fractures are closely associated with Dauphiné twins and are filled with amorphous silica (glass), widely considered to be a classic indicator of shock metamorphism. Thus, this study confirms that glass-filled shock fractures in quartz form during near-surface nuclear airbursts, as well as crater-forming impact events, and by extension, it suggests they also may form in near-surface cosmic airbursts.

Abstract Background Context Pelvic ring fractures are becoming more common in the aging population and can prove to be fatal, having mortality rates between 10% and 16%. Stabilization of these fractures is challenging and often require immediate internal fixation. Therefore, it is necessary to have a biomechanical understanding of the different fixation techniques for pelvic ring fractures. Methods A previously validated three-dimensional finite element model of the lumbar spine, pelvis, and femur was used for this study. A unilateral pelvic ring fracture was simulated by resecting the left side of the sacrum and pelvis. Five different fixation techniques were used to stabilize the fracture. A compressive follower load and pure moment was applied to compare different biomechanical parameters including range of motion (contralateral sacroiliac joint, L1-S1 segment, L5-S1 segment), and stresses (L5-S1 nucleus stresses, instrument stresses) between different fixation techniques. Results Transiliac -trans sacral screw fixation at S1 and S2 showed the highest stabilization for horizontal and vertical displacement at the sacral fracture site and reduction of contralateral sacroiliac joint for bending and flexion range of motion by 165% and 121%, respectively. DTSF (Double transiliac rod and screw fixation) model showed highest stabilization in horizontal displacement at the pubic rami fracture site, while the L5_PF_W_CC (L5-Ilium posterior screw fixation with cross connectors) and L5_PF_WO_CC ( L5-Ilium posterior screw fixation without cross connectors) showed higher rod stresses, reduced L1-S1 (approximately 28%), and L5-S1 (approximately 90%) range of motion. Conclusions Longer sacral screw fixations were superior in stabilizing sacral and contralateral sacroiliac joint range of motion. Lumbopelvic fixations displayed a higher degree of stabilization in the horizontal displacement compared to vertical displacement of pubic rami fracture, while also indicating the highest rod stresses. When determining the surgical approach for pelvic ring fractures, patient-specific factors should be accounted for to weigh the advantages and disadvantages for each technique.

Reactivation of pre-existing weaknesses in the upper crust can be documented using surface features, and has occurred throughout time and space, particularly in regions where the basement material dates from the Precambrian and has undergone successive deformation events. This study aims to use surface features such as fracture patterns to document evidence of such reactivation in the Paleozoic and Cenozoic of Nebraska and Kansas (units separated by an unconformity in the study area). The most prominent basement features in southeast Nebraska and northeast Kansas are oriented NE-SW, likely related to the midcontinent rift, and oriented NW-SE, likely related to fabrics from the Central Plains Orogen. These features are well defined in the potential fields data. Fracture patterns in the study area show an E-W oriented trend, as well as clearly discernable NE-SW and subsidiary N-S and NW-SE trends. The E-W trend is interpreted to be related to far-field stresses from Laramide and Ancestral Rocky Mountain orogenic events, whilst the NE-SW trend is interpreted to be related to subtle reactivation on the Mid-continent rift and related faults, observed in basement data. These movements produced stresses of sufficient magnitude to produce extensional fractures in the overlying rock units, but not sufficient to generate shear. Similarly, the ~N-S and NW-SE fracture trends are taken as evidence of subtle reactivation on the Nemaha Uplift and Central Plains Orogen systems, generating fractures but not shear movement. This contribution therefore provides a convincing case-study of the value of fracture orientations (that is, surface morphodynamics) in discerning buried tectonic trends and subtle reactivation thereon.

Background and objectives Osteoporotic vertebral compression fractures, particularly prevalent among the aging population, constitute a pressing global healthcare challenge. They often are unnoticed until severe pain and disability manifest, making them an underdiagnosed and undertreated condition. Patients who suffer from these fractures not only endure excruciating pain but also face diminished quality of life, impaired mobility, and the risk of respiratory compromise due to altered spinal alignment. The economic repercussions of vertebral compression fractures are substantial. Hospitalization costs, rehabilitation expenses, long-term care, and indirect costs related to lost productivity significantly burden healthcare systems and society at large , offering a promising avenue for enhancing patient outcomes and relieving the healthcare and societal financial strain posed by vertebral compression fractures. Kyphoplasty, a minimally invasive surgical technique, offers rapid pain relief, vertebral height restoration and improved function. Recognizing the importance of early intervention, this manuscript highlights the potential of kyphoplasty in mitigating both clinical and economic consequences. By addressing these fractures more effectively, kyphoplasty may potentially reduce long-term healthcare expenses and indirect costs. Material and Methods 66 randomized patients were divided into 2 treatment groups (kyphoplasty using single balloon and double balloon), analyzing radiographic and clinical parameters during 12 months of follow-up. Results Patients treated with double balloon obtained greater anterior and posterior vertebral height after reduction and a better local vertebral angle. Both groups of patients obtained clinical improvement after treatment (VAS and ODI), with no differences between the groups. Conclusion Patients treated with double balloon kyphoplasty had better radiographic results. This revision manuscript delves into the critical dimensions of these fractures, encompassing demographics, clinical consequences, challenges in diagnosis and management, and their profound economic impact. This manuscript serves to introduce an improved kyphoplasty technique to guide to the multifaceted nature of osteoporotic vertebral compression fractures and their management.

The increasing prevalence of periprosthetic femoral fractures, specifically in the vicinity of the hip, has emerged as a significant issue in recent times. Consequently, there is a need for a thorough examination to enhance the effectiveness of management and treatment approaches. The findings emphasized a significant disparity in the occurrence and characteristics of these fractures, as multiple studies have highlighted the efficacy of various treatment strategies, such as open reduction and internal fixation, as well as the utilization of cortical strut allografts. Furthermore, the research has identified potential risk factors that have an impact on the characteristics of fractures, providing valuable insights that could be crucial in the development of preventive strategies. This research provides a thorough examination of periprosthetic femoral fractures, highlighting the importance of a cohesive treatment algorithm to improve the handling of such fractures. Moreover, it promotes the need for a collaborative endeavor in conducting research in this field, cultivating a more profound comprehension that has the potential to drive progress in therapeutic approaches, ultimately enhancing patient results over an extended period of time. It is crucial that forthcoming research endeavors persist in expanding upon these discoveries, striving towards a unified methodology in tackling this substantial clinical obstacle.

Study design: Technical note. Objectives: To present a new technique of treatment for a patient with thoracolumbar focal kyphosis due to osteoporotic verte-bral fracture (OVFs). Background : OVFs are common among the elderly population. Following a severe wedged fracture, patients often experience low back pain and disruptions in activities of daily living. Reconstruction surgeries, such as corpectomy, are among the treatment options for this condition. However, corpectomy requires longer surgical times and involves a significant amount of blood loss. Materials and Methods : An 80-year-old woman presented to our hospital with severe low back pain and gait disturbance. She had experienced an L2 OVF six years prior. Although she had no neurological deficit, she could not walk more than 200m due to pain. Preoperative spinal radiographs revealed severe sagittal malalignment, with the L2 vertebra collapsed and focal kyphosis of L1-3 measuring 34 degrees. Results: The patient underwent anterior and posterior surgery in the right decubitus position using a C-arm free technique. The surgical time was 133 minutes with an estimated blood loss of 100 ml. Hyperlordotic cages were inserted in the upper and lower disc space via a lateral approach, while percutaneous pedicle screws (PPS) were inserted from a posterior approach. These procedures were performed simultaneously under navigation guidance only. Post-operative images showed excellent spinal alignment, with local kyphosis reduced from 34 to 14 degrees, and no major or severe complications occurred. At one-year follow-up, the patient was able to walk smoothly, with her visual analogue scale for low back pain improving from 73mm to 13mm, and her Oswestry Disability Index improving from 53.3% to 13.3%. Conclusions/Level of Evidence : The simultaneous use of hyperlordotic cages and PPS is an effective and innovative navigation technique that yields promising outcomes for thoracolumbar focal kyphosis resulting from OVFs. This approach not only reduces surgical time but also minimizes intraoperative blood loss. Level V.

Background: Diabetes mellitus (DM) and osteoporosis are two of the most widespread metabolic disease in the world. The aim of this study is to investigate the prevalence of DM among patients affected by osteoporosis and fragility fractures, and to search differences in clinical features. Methods: 713 patients belonging to CTO Bone Unit because of osteoporosis and fragility fractures were divided into two groups, according to the diagnosis of DM. The clinical and bone characteristics of patients were compared. Results: Prevalence of DM was 10.8%. When compared to patients without DM, the median age at the time of first fracture was similar (72 years ± 14 IQR vs 71 years ± 12 IQR); prevalence of combination of vertebral and hip fractures was higher (p=0.039), as well as prevalence of males, although not significantly (p=0.051). Bone mineral density (BMD) at all sites was higher in DM group; Trabecular Bone Score (TBS), instead, was significantly lower (p&lt;0.001). Conclusions: Patients with fragility fractures and DM more frequently show combination of major fractures with higher BMD levels. In these patients, TBS could be a better indicator of bone health than BMD and therefore should be used as a diagnostic tool in clinical practice.

Abstract: Unusual methane emission and spontaneous combustion of coal induced by the air leakage are both hazards during mining. The most common practice has been to improve mine safety is sealing the mining fractures. In this paper, the methane and geology, coal spontaneous combustion characteristics and the coexistence of methane emission and spontaneous combustion of coal were analyzed. The preparation system of inorganic solidified foam (ISF) in field applications is studied and the working principle of generating device consists of foam generator and mixer was expounded. The technical plan of site construction is that the foam fluids was injected to respectively seal the mining fractures behind hydraulic supports, the cavities of air return corner, and the fractures nearby the coal pillar. After the foam fluids injection, the two stress values in the coal pillar eventually maintained above 15.5Mpa and 13Mpa, respectively. It indicated that the ISF can enhance the bearing stress ability of the coal pillar by transforming the stress state from two dimensional to three dimensional. The methane concentration in the air return corner and air return roadway declined significantly to 0.63% and 0.25%. The differential pressure inside and outside of the 4301(1) goaf fluctuated between -100pa to 150pa and the concentration of CO and O2 declined to 9ppm and 6%. The CO concentration in the air return corner finally reached a stable level of 6ppm. What that all means, the foam fluids can seal the air leakage and inhibit spontaneous combustion of coal effectively.

Background and purpose: Total elbow arthroplasties (TEA) aim to replicate anatomy and provide stability in the treatment of distal fractures of the humerus. In the presence of an aging population with higher functional demand, improving patients’ well-being is crucial. This study aimed to analyze patients’ reported outcomes and functional outcomes for TEA in comminuted fractures of the distal humerus and to compare these outcomes with their counterpart patients who have been treated with open reduction and internal fixation (ORIF). In addition, this study aims to compare the secondary procedures rate between the two groups.Patients and Methods: Eligible patients were those who underwent TEA or ORIF of the distal humerus and completed several patient-reported outcome (PRO) questionnaires including the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, 12-Item Short Form Health Survey Physical and Mental components (SF-12 P and SF-12 M, respectively) scores, visual analog scale (VAS) score for pain, and patient satisfaction ratings (1-5). A physical examination including range of motion, instability, and strength was performed for all patients. Results: This study found that patients following TEA have shown significantly lower pain levels (TEA: 3.72±2.8; ORIF 5.2±2.98, P=0.019) and higher satisfaction levels (TEA: 4.18±1.17; ORIF 3.57±1.46, P=0.035) compared with patients following ORIF. DASH score (TEA: 33.7±29.4; ORIF 39.75±24.6, P=0.31) and SF-12 score (TEA: 31.7±9.67; ORIF 31.25±10.2, P=0.85) were not statistically different between TEA and ORIF.Patients following TEA have demonstrated an advantage in flexion compared with patients following ORIF (P=0.045). Both patients following TEA and ORIF demonstrated no statistically significant difference in pronation and supination of the operated elbow compared to the contralateral side. Although, a decreased range in extension and flexion of the operated elbow compared with the contralateral side was demonstrated in both groups (extension P=0.005, flexion P<0.001). The grip Test showed no significant difference between the patients who were treated by TEA or ORIF (P=0.99). Moreover, ORIF in comminuted fractures of the distal humerus in elders may be associated with a higher complication rate compared with TEA.Conclusion: TEA following comminuted fractures of the distal humerus is associated with favorable satisfaction, pain levels, and range of motion in flexion compared with patients following ORIF of the distal humerus. Additionally, TEA may be associated with a lower rate of secondary procedures.

Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Orthogeriatric co-management units have increased quality of care, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms “hip fracture”, “geriatric assessment”, “second hip fracture”, “surgery”, “perioperative management” and “orthogeriatric care”, in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.

Introduction: Suicide is the second leading cause of death among 15 to 19-years-olds in Europe. From the beginning of COVID-19 pandemic, literature confirms a significant increase in mental health disease in children and adolescents. At Bambino Gesù Pediatric Hospital emergency department (Rome, Italy) there was a dramatic increase of suicidal attempts, and particularly a rise of suicidal jumpers. Many of these patients presented vertebral fractures. Material and Methods: This retrospective study includes all suicidal jumpers with vertebral fractures treated at our Pediatric Hospital from April 1, 2017 to March 31, 2023. We collected and compared data from three years before to three years after pandemic spreading analyzing vertebral fractures. Results: From April 1 2019 to March 31, 2020 141 cases of suicide attempt arrived at Bambino Gesù Pediatric Hospital emergency department. Five of these patients were suicidal jumpers but none had a vertebral fracture. From April 1, 2020 to March 31, 2023, 362 cases of suicide attempts arrived in the same emergency department and 19 were suicidal jumpers; 12 reported vertebral fractures and were included in this study. Mean age was 14 years. Most common level of fracture was L1. Four patients presented with preoperative neurologic impairment and two cases recovered completely. There was a transforaminal sacral fracture, a spinopelvic dissociation and an Anderson-D’Alonso C2 type II fracture. Two cases with thoracolumbar vertebral fractures were conservatively treated. Seven patients were treated by percutaneous pedicle fixation to achieve an indirect decompression and to restore a better sagittal balance. Only three patients needed an open spinal surgery by posterior approach and in two cases a posterior decompression was performed. One case with cervical fractures was treated by Halo-Vest. Conclusions: Recent literature highlights concern about the consequences of COVID-19 pandemic on pediatric population mental health. This is the first report that shows a significant increase in vertebral body fractures due to suicide jumping attempt. The comparison between three years pre and post pandemic is sufficient to demonstrate a sharp increase of these cases. This could be a new epidemiological phenomenon that could persist or even increase over time because of COVID-19 pandemic.

Based on the engineering background of Daliuta mining area, the fracture distribution and water movement within the weakly cemented overlay strata are studied through liquid-solid coupling physical simulation and COMSOL numerical simulation test. 3D fracture network of overburden strata in mining is plotted based on the result of the physical simulation test. The results showed that the ‘fractured zone’ of the weakly cemented overburden strata in the western area develops more evidently than that in the eastern area ---- wide-opened fractures form at both ends of the working area and this leads to a wide distribution of fractures in the overlying strata.After the initial caving of the roof, height of the penetrating fractures increases rapidly and the separated strata space becomes the main channel for water flow. Under the action of water flow and rock strata movement, mining-induced fractures in overlying rock display cyclic change of expansion, penetration and closure. When the working face is fully mined, the penetrating fractures in the overlying strata and mining-induced fractures up in the working face become the main passages for water flow. The experimental result provides a reference for underground reservoirs layout and maintenance and water-conserved mining in western China.