Epoxy matrix composites reinforced with high-performance fibers such as carbon, Kevlar, and glass, exhibit excellent specific stiffness and strength in many mechanical applications. However, these composites are disappointingly non-recyclable and are usually disposed of in landfill sites, with no realistic prospect for biodegradation in reasonable time. In contrast, moldable composites with carbonized elastomeric matrices developed in the last decades possess attractive mechanical properties in final net-shape products and can also be incinerated or recycled. Many carbon and inorganic fillers have recently been evaluated to adjust the properties of carbonized elastomeric composites. Renewable organic fillers such as human or animal hair offer an attractive fibrous material with substantial potential for reinforcing composites with elastomeric matrices. Samples of unidirectional fiber composites (with hair volume fraction up to 7 %) and quasi-isotropic short fiber composites (with hair volume fraction up to 20 %) of human hair-reinforced nitrile butadiene rubbers (HH-NBR) were produced in the peroxide-cured and carbonized states. The samples were characterized using SEM, Raman spectroscopy and photoacoustic microscopy. Mechanical tests were performed in tension using a miniature universal testing machine. The expected effect of fiber reinforcement on the overall mechanical performance has been demonstrated for both cured and carbonized composites. Considerable enhancement of the elastic modulus (up to 10 times), ultimate tensile strength (up to 3 times) and damage tolerance was achieved. The evidence of satisfactory interfacial bonding between hair and rubber was confirmed by SEM imaging of fracture surfaces. The suitability of photoacoustic microscopy was assessed for 3D reconstruction of the fiber sub-system spatial distribution and non-destructive testing.

This paper conducts an extensive literature review focusing on the utilisation of crack tip plasticity as a crucial parameter in determining and enhancing crack growth models. The review encompasses a comprehensive analysis of various methodologies, predominantly emphasising numerical simulations of crack growth models while also considering analytical approaches. Although experimental investigations are not the focus of this review, their relevance and interplay with numerical and analytical methods are acknowledged. The paper critically examines these methodologies, providing insights into their advantages and limitations. Ultimately, this review aims to offer a holistic understanding of the role of crack tip plasticity in the development of effective crack growth models, highlighting the synergies and gaps between theoretical, experimental, and simulation-based approaches.

Osteoporotic spinal fractures represent an increasingly widespread health problem in our aging society. We aimed to investigate the treatment options for low-energy spinal fractures in the el-derly and their impact on mortality, focusing on surgical stabilization using minimally invasive and open techniques. We evaluated 1356 patients over 50 years of age with compression frac-tures sustained due to low energy trauma treated at a single trauma center. We compared the mortality of patients following stable and operated/non-operated unstable compression frac-tures and the eligibility to surgery using the open and minimally invasive approach. The pa-tients received surgical or conservative care according to severity and eligibility to surgery. The mortality hazard ratio of patients who underwent screw fixation was 1.02 (P > .91), of patients who refused surgery was 1.68 (P < .001) and that of patients with anesthesiological contraindica-tion was 1.57 (P = .08), compared to conservatively treated patients with stable fractures. The dif-ference in mortality between open and minimally invasive surgeries was not significant, but the number of patients eligible for surgery with the minimally invasive procedure was significantly higher (OR: 0.25; P < .001). Spinal stability after fractures may be an important predictor of sur-vival in patients with low-impact fractures.

Numerous reservoirs that play a significant role in worldwide petroleum production and reserves contain fractures. Typically, the fractures must form a connected network for a reservoir to be classified as naturally fractured. Characterizing the reservoir with a focus on its fracture network is crucial for modeling and predicting production performance. To simplify the solution, dual continuum modeling techniques are commonly employed. However, to use continuum-scale approaches, properties such as average aperture, permeability, and matrix fracture interaction parameters must be assigned, making it necessary to improve fracture depiction and modeling methods. This study investigates a fractured reservoir with a low matrix permeability and a well-connected fracture network. The focus is on the impact of the hyrachical fracture network on the production performance of gas-based enhanced oil recovery methods. The Discrete Fracture Model (DFN) was utilized to create comprehensive two-dimensional models for three processes: Gas Injection (GI), Water Alternating Gas (WAG), and Foam Assisted Water Alternating Gas (FAWAG). Moreover, dimensionless numbers were employed to establish connections between properties across the entire fracture hierarchy, spanning from minor to major fractures and encompassing the fracture intensity. The results indicate that the FAWAG is more sensitive to fracture types and networks than the WAG and GI processes. Hence, the sensitivity of the individual EOR method to the fracture network requires a respective depth of description of the fracture network. However, other factors, such as reservoir fluids properties and fracture properties, might influence the recovery when the minor fracture networks are excluded. This study has determined that, among the enhanced oil recovery (EOR) techniques examined, the significance of the hyrachical depth of fracture networks diminishes as the ratio of major (primary fracture) aperture to the aperture of medium and minor fractures increases. Additionally, the impact of the assisted-gravity drainage method was greater with increased reservoir height; however, as the intensity ratio increased, the relative importance of medium and minor fracture networks decreased.

Our daily activities hinge on the flexibility of our fingers, and a fractured finger can significantly disrupt these routines. The finger bones enable us to bend and fold the fingers and thumb to pick up or grasp objects and do all of our daily activities. A broken finger can cause adverse effects on our daily life activities. It is important to treat broken finger as soon as possible. Swift and precise treatment begins with capturing multiple X-rays, followed by the critical step of fracture detection in these images. Relying on the naked eye for this task carries the risk of overlooking small fractures. To address this issue an automated diagnoses of fractured fingers from images is required for which the current research employs advanced deep learning models—ResNet34, ResNet50, ResNet101, ResNet152, VGG-16, and VGG-19—to classify finger images from the Musculoskeletal Radiographs (MURA) dataset as either fractured or non-fractured. The results emphasize the consistently strong performance of ResNet models, attaining an impressive accuracy of 81.9%. This surpasses VGG models by 3.4% and establishes ResNet as the new benchmark for state-of-the-art accuracy.

This study comprehensively investigates Al2O3's mechanical properties, focusing on fracture toughness, surface energy, Young's modulus, and crack propagation. The density functional theory (DFT) is employed to model the vacancies in Al2O3, providing essential insights into this material’s structural stability and defect formation. The DFT simulations reveal a deep understanding of vacancy-related properties and their impact on mechanical behavior. In conjunction with molecular dynamics (MD) simulations, the fracture toughness and crack propagation in Al2O3 are explored, offering valuable information on material strength and durability. The surface energy of Al2O3 is also assessed using DFT, shedding light on its interactions with the surrounding environment. The combination of DFT and MD simulations provides a robust framework for a comprehensive understanding of Al2O3's mechanical properties, with implications for material science and engineering applications.

An 11-month-old castrated male Pomeranian presented with nonunion following a femoral fracture that occurred after femoral head and neck osteotomy. Radiography and computed tomography revealed severe atrophy of the proximal bone fragment and retardation of the ipsilateral distal fragment and tibia. An autogenous bone graft using coccygeal bone was performed, in which three-and-a-half coccyges were placed in series and fixed using an orthogonal locking plate. To promote bone healing and facilitate proper weight bearing and ambulation, bone morphogenetic proteins, biphasic calcium phosphate, platelet-rich plasma, passive range of motion exercises, transcutaneous electrical nerve stimulation, neuromuscular electrical stimulation, and low level laser therapy were applied. During the four-year follow-up, it was observed that the previously engrafted bone healed well and maintained stability over a prolonged period, resulting in the patient being able to walk and trot comfortably with good outcomes. However, some degree of lameness was noted during galloping owing to limb shortening and joint contracture.

China is rich in coal resources under water bodies. However, for a long time, the safety prediction of high-intensity mining under water bodies is one of the problems encountered by the coal industry. It is of great significance to realize safe mining under water bodies, improve the recovery rate of coal resources and protect reservoir resources. Therefore, this article takes the No. 5 coal seam and No. 11 mining area of Wangwa Coal Mine as the research object, and integrates physical simulation, numerical simulation, theoretical analysis and other methods to study the development height of water-conducting fracture zones in fully mechanized top coal caving mining. Solid-liquid coupling physical simulation test reveals the failure characteristics of overlying strata in goaf and the seepage law of reservoir water under the influence of mining. By comparing the monitoring data of borehole leakage, the measured data obtained by borehole peeping with the height data of water-conducting fracture zone obtained by the traditional empirical formula of three-under standard, the error between the two is as high as -29.39 %. In this case, the variance correction coefficient is used to correct the empirical formula, and on this basis, in order to effectively protect the surface water dam and water body, the mining height of coal seam in the working face with limited height mining is inversely derived. The research results provide a basis for the safety prediction of high-intensity mining under the reservoir dam in the ecologically fragile areas of western China and provide a scientific guarantee for the formulation of safety measures under such conditions.

In this paper, through high-temperature tensile tests of 55NiCrMoV7 steel, the high-temperature fracture behavior, microstructure evolution and carbide distribution characteristics of both thermal-mechanical coupling zone (fracture zone) and thermal stress zone (clamping zone) at different temperatures were studied. Intrinsic relationship between high temperature fracture and carbides types, distribution and size were revealed and evolution mechanism of microstructure near cracks in 55NiCrMoV7 hot-working die steel during high temperature deformation was clarified. Samples were stretched at different temperatures from 25 °C to 700 °C, and microscopic examinations were carried out by using SEM and TEM. The results showed that: With the increase of temperature, tensile strength and yield strength decreased, elongation and reduction of area increased, and fracture mode changed from brittle fracture to ductile fracture by transition temperature at about 400℃. During high temperature deformation, the grain dislocation density decreased, the tempered martensite decomposed, recovered, recrystallized, and then grain grew. M7C3 and M23C6 carbides precipitated and grew along the grain boundary, and a small amount of fine granular MC carbides were dispersed in the grain. The work done by the external force on the deformation zone would cause the temperature of it to be higher than tensile temperature, which provides thermodynamic conditions for the re-dissolution of small carbides near the fracture zone and the grain growth of large carbides, resulting in the decrease of small carbides and increase of large carbides in thermal-mechanical coupling zone.

This study investigated the mechanical properties and fatigue behavior of FH36 steel plate rolled in different directions. By adopting a sequential rolling process in the rolling direction (RD) and transverse direction (TD), the differences in properties between RD and TD were eliminated, resulting in nearly identical tensile properties. The steel plate exhibited a yield strength of approximately 420 MPa, a tensile strength of approximately 506 MPa, and an elongation of approximately 25%. Fatigue tests conducted at room temperature and -60℃ showed a fatigue limit of the maximum stress of 488 MPa at room temperature and 500 MPa at -60℃, indicating improved low-temperature fatigue performance. The fracture surfaces displayed distinct characteristics, such as oblique shearing fractures for high-cycle fatigue and cup-cone shape fractures for low-cycle fatigue. The fatigue source zone were both on the surface of the specimens. As the maximum stress increased, the area of the crack propagation zone for high-cycle fatigue decreased, while the area of the final fracture zone, the number of dimples and the proportion of the LAGBs increased.

The purpose of this study was to explore and develop high-resolution infrared thermal (HRIT) imaging for screening toddler’s fracture. A Toddler’s fracture is a common tibial fracture of children younger than 6 years old. Initial x-ray radiographs may not show the fracture and another x-ray during a follow-on visit is usually required. The study included 39 participants admitted to an emergency department with a suspected toddler’s fracture. X-ray confirmed 8 cases with a toddler’s fracture (20.5%). Infrared images of participants were recorded on their index visit, focusing on region-of-interests on the injured and the contralateral (uninjured) legs. The uninjured leg acted as a thermal reference. Nine statistical measures were extracted from the images: maximum, mini-mum, mean, standard deviation, median, mode, interquartile range, skewness, and kurtosis. Wilcoxon rank sum test indicated that maximum, mean, standard deviation, median, and inter quartile range temperature measures were significantly different (p<0.05) when comparing fractured and non-fractured legs. Principal component analysis of these measures highlighted distinct separation of toddler’s fracture and non-fracture cases. Similarly, plots of the statistical measures further confirmed clustering of toddler’s fracture cases. The study demonstrated that HRIT imaging can be a valuable tool for screening for toddler’s fracture.

In the present work, the effects of ageing treatment on the microstructures of a near-β Ti alloy (TC18) are studied. The influence of ageing treatment on the tensile properties and failure mechanisms are systematically analyzed. It is found that the size and morphology of the primary α (αp) phases are insensitive to ageing temperature and time. Furthermore, the ageing temperature and time dramatically influence the precipitation of the secondary α (αs) phases. Massive αs phases precipitate and gradually coarsen, and finally weave together with increasing the ageing temperature or extending the ageing time. The thickness of αs phases is responsible for the material strengths, while the content of α phases can enhance the material ductility. The ductile characteristics of the alloy with coarser αs phases are more obvious than those with thinner αs phases. Therefore, the ageing treatment is helpful for the precipitation and homogeneous distribution of αs phases, which is essential for balancing the strengths and ductility of the studied Ti alloy.

Forensic anthropologists play a key role in skeletal trauma analysis and commonly use macroscopic features to distinguish between trauma types. However, this approach can be challenging, particularly in cases of highly comminuted or incompletely recovered fractures. Histological analysis of microscopic fracture characteristics in fractured bones may thus help provide additional information on trauma type and bone fracture biomechanics in general. This study analysed the extent of microcrack damage to osteons in long bones with blunt force trauma (BFT) and gunshot trauma (GST), from both traumatic death cases and post-mortem experimental fractures. We identified four types of osteonal damage (OD). In traumatic death cases, OD affecting the inside of the osteon and compromising the Haversian canal (type 1) was found to be indicative of BFT. Moreover, OD affecting the cement line (type 3) and interstitial lamellae (type 4) was more common in the GST samples. OD affecting the inside of the osteon without compromising the Haversian canal (type 2) was not found to be indicative of either trauma type. In cases of experimental fractures, our study revealed that post-mortem fractures in dry bone samples featured the highest amount of OD, particularly of type 4. This study also found that the experimentally produced GST featured similar OD pattern to GST death cases. These findings support our hypothesis that there are distinct osteonal damage patterns in human long bones with BFT and GST, which are of relevant value for trauma analysis in forensic anthropology.

The Reactive Spark Plasma Sintering (R-SPS) method is compared in this work with the two-steps SHS-SPS route, based on combination of the Self-propagating High-temperature Synthesis (SHS) with the SPS process, for the fabrication of dense (Hf0.2Mo0.2Ti0.2Ta0.2Nb0.2)B2-SiC and (Hf0.2Mo0.2Ti0.2Ta0.2Zr0.2)B2-SiC ceramics. A multiphasic and inhomogeneous product, containing various borides, is obtained at 2000°C/20min by R-SPS, from transition metals, B4C and Si. In contrast, if the same precursors are first reacted by SHS, and then processed by SPS under the optimized condition of 1800°C/20min, the desired ceramics are successfully attained. Both High-Entropy-Boride/SiC products display densities > 97%, uniform microstructures and contained only small amounts of residual oxides (<2.4 wt.%). The presence of SiC makes the sintering temperature milder, i.e. 150°C below to that needed by the corresponding additive-free system. Fracture toughness is also markedly improved, particularly when considering the Nb-containing system processed at 1800°C/20min, whereas KIC progressively decreases (from 7.35 to 5.36 MPa m1/2) as the SPS conditions become more severe. SiC addition is found to inhibit the volatilization of metal oxides like MoO3 formed during oxidation experiments, thus avoiding mass loss in the ceramics. The benefits above also likely take advantage of the fact that the two composite constituents are synthesized in parallel, according to the SHS-SPS approach, rather than being produced separately and combined subsequently, so that strong interfaces between them are formed.

Cervical injuries from athletic activities are rare; they can have severe consequences if not diagnosed and managed promptly. The choice of diagnostic imaging modality is pivotal in ensuring timely and accurate diagnosis. We detail the case of a 19-year-old female athlete who sustained a C2 Durel Type II Subclass C fracture during a short-track speed skating championship. Initial evaluation using X-ray imaging at the athletic center medical facility did not detect the injury, allowing her to continue competing. Persistent pain led to further evaluation at our institution, where MRI and CT scans confirmed the fracture. Approximately 45 days post-injury, the patient underwent a successful surgical intervention utilizing O-arm CBCT navigation for C1-C2 dorsal fusion. Post-surgery, she embarked on a comprehensive rehabilitation program and fully recovered within 12 weeks. This case underscores the limitations of relying solely on X-ray imaging for diagnosing cervical fractures post-trauma. Our findings advocate prioritizing CT scans as a primary diagnostic tool in such scenarios, emphasizing the need for a robust diagnostic approach to ensure athlete safety and well.

Introduction: Postoperative epidural hematomas of the cervical and thoracic spine can pose a great risk of rapid neurological impairment and sometimes require immediate decompressive surgery. Case Report: We present the case of a young patient operated on for stabilization of a two-level thoracic vertebra fracture who developed total paralysis due to an epidural hematoma postoperatively. The course of epidural hematoma was quickly reversed with the help of a con-servative technique that prevented revision surgery. The patient regained complete neurology on follow-up without any recurrent episodes. Conclusion: There is a role of similar maneuvers as described in this case to be employed in the management of postoperative epidural hematomas. However, prolonged watchful waiting should still be discouraged, and patients should remain ready for revision surgery if there are no early signs of rapid recovery.

The management of blunt abdominopelvic trauma with combined hemoperitoneum and pelvic fractures is challenging for trauma surgeons. Although angioembolization can achieve hemostasis in most visceral organ injuries and pelvic fractures after blunt abdominal trauma, it cannot effectively control hemorrhage in patients with blunt bowel mesenteric injury (BBMI). This study aimed to determine the risk factors associated with hemodynamically unstable patients with BBMI and to test the hypothesis that pelvic fracture is an independent risk factor for patients with unstable BBMI and concomitant pelvic fracture to guide the therapeutic sequence for difficult-to-manage patients. This retrospective study reviewed the data of hospitalized patients with trauma between 2009 and 2021 and included 158 adult patients with surgically proven BBMI. The patients were divided on the basis of the presence of a shock episode before emergency laparotomy. The shock group included 44.3% of all patients in the study (n = 70). Clinical injury severity and prognosis for patients in the shock group were poorer than those for patients in the non-shock group, and more invasive treatments and transfusions were performed for patients in the shock group than for those in the non-shock group. Pelvic fractures were more frequently associated in the shock group than in the non-shock group (21.4% vs. 5.7%; p = 0.003). In multivariate analysis, the presence of intracerebral hemorrhage (odds ratio [OR] = 10.87, 95% confidence intervals [CIs]: 1.70–69.75) and rib fracture (OR = 5.94, 95% CIs = 1.06–33.45) were identified as independent predictors of shock, whereas the effect of pelvic fracture did not achieve statistical significance (OR = 2.94, 95% CIs = 0.66–13.13) after adjusting for confounding factors. For patients with BBMI, outcomes need to be improved during early diagnosis and treatments should be expeditiously performed on the basis of the rapid identification of unstable hemodynamic status. In unstable patients with concomitant pelvic fractures, we support the current management algorithm that recommends performing laparotomy first.

This research investigates the fatigue behaviour and fracture mechanics of high-performance concrete (HPC), including various compositions such as HPC with basalt aggregates (HPC-B), HPC with gravel (HPC-G), and high-strength coarse mortar (CM) static and cyclic tensile loading within the special priority program SPP 2020. The study aims to integrate fracture mechanics into structural analysis to enhance design guidelines for slender cross-sections and safety-related high-performance structural components. The experimental investigations reveal HPC-B's re-markable superiority, displaying higher compressive strength, modulus of elasticity, and tensile strength compared to HPC-G and CM. A modified disk-shaped compact tension (MDCT) based on ASTM standards, aided by digital image correlation (DIC) unveils fracture behaviour, empha-sizing fracture energy as a crucial parameter. HPC-B exhibits improved crack resistance and notch sensitivity reduction attributed to crushed basalt aggregates and enhanced interfacial transition zone (ITZ). The research scrutinizes factors like material characterization, aggregate morphology, stress levels, and displacement rate on crack formation. High-cycle fatigue tests show HPC-B's superior performance, and post-fatigue analysis reveals enhanced residual fracture toughness attributed to nano-level structural changes, stress redistribution and aggregate-matrix interac-tion. 3D image analysis via Computed Tomography (CT) scans captures mesostructural crack propagation and provide quantitative insights. This study advances the understanding of HPC fatigue behaviour, emphasizing the interplay of aggregate types, morphologies, and their dy-namic response to cyclic loading, offering valuable insights for optimizing design guidelines and fostering innovation in structural engineering.

We investigated the biomechanical behaviour of different fixations of the tibial posterior malleolus (TPM), simulating distinct situations of involvement of the tibiotalar articular surface (TTAS) through a finite element model (FEM). A 3D computer-aided design model of the left ankle was obtained. The materials used were divided according to their characteristics into ductile and non-ductile, and all materials were assumed to be linear elastic, isotropic, and homogenous. Three different fracture lines of the TPM were defined, with sagittal angles of 10º, 25º, and 45º. For biomechanical comparison, different constructions using a trans-syndesmotic screw (TSS) only (Group T), a one-third tubular plate only with (Group PT) and without (Group PS) a TSS, and a locked compression plate with (Group LCPT) and without (Group LCPS) a TSS were tested. FEM was used to simulate the boundary conditions of vertical loading. Load application regions were selected in the direction of the 700N Z axis, 90% on the tibia and 10% on the fibula. Data on the displacement and stress in the FEM were collected, including the total principal maximum (MaxT) and total principal minimum (MinT) for non-ductile materials, total displacement (desT), localized displacement at the fragment (desL), localized displacement at syndesmosis (desS), and Von Mises equivalent stress for ductile materials. The data were analyzed using ANOVA and multiple comparison LSD tests were used. For TPM fractures with a sagittal angles 10º and 25º, desL in the PT and LCP groups was significantly lower, as well as Von Mises stress in Group LCPT in 10º, and PT and LCPT groups in 25º. TPM fractures with a sagittal angle of 45º, desL in the LCP group and Von Mises stress in Group LCPS and LCPT was significantly lower. We found that any TPM fracture may indicate instability of the distal tibiofibular syndesmosis, even when the fragment is small. Our study showed that in fragments involving 10% of the TTAS, the use of a TSS is sufficient, but when the involvement is greater than 25% of the TTAS, either non-locked or locked plate must be used to buttress the TPM. In posterior fragments affecting 45% or more of the TTAS, the use of a locking plate is recommended.

In response to a threefold increase in osteoporotic vertebral fractures (OVF) at our institution over the past decade and the subsequent development of new fractures within a year in a third of cases, we evaluated the effectiveness of STIR MRI scans in conjunction with CT scans for initial OVF diagnosis. This study, conducted over five months, involved full spine sagittal STIR MRI scans alongside CT scans for patients over 50 with minor injury-related vertebral fractures. The independent assessments by radiologists and neurosurgeons of 64 patients revealed that while CT scans identified 161 fresh fractures, of which only 68 were previously reported, MRI detected 266 fractures, 1.65 times more than CT. CT scans showed single fractures in 27% of patients and multiple fractures in 73%, whereas MRI identified single fractures in 9% and multiple fractures in 91% of patients. Additionally, MRI demonstrated a 1.5-fold increase in adjacent fracture detection. The use of MRI influenced treatment plans in 67% of cases. Given these findings, we advocate for including a STIR MRI of the entire spine alongside CT scans in OVF cases, as it significantly enhances fracture detection and can alter treatment strategies.

Introduction: Bone fractures may be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, osteopenia, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture. Bone cancer can be primarily or secondary to metastasis. Case presentation: We report a rare case of left humerus fracture in a 59-year-old male patient due to metastatic renal cell carcinoma. Our patient had no important past medical history. He suffered from two months of left arm pain, moderate disability and fever at night. Analgesics consumption resulted in minimal relieve. Trauma history was negative. X-ray of the left arm showed an osteolytic lesion with humerus fracture. Abdominal computed tomography with contrast showed right renal mass.Radical right nephrectomy was performed in addition to alignment nailing of the left humerus fracture with biopsy. Pathology report documented clear cell carcinoma with metastatic bone. The treatment was completed by chemotherapyDiscussion: Secondary bone tumors are metastatic lesions which have spread from other organs, most commonly carcinomas of the breast, lung, and prostate, and rarely from kidney. In some cases, bone metastasis could be the first symptoms of renal cell carcinoma. Conclusion: suspected pathological bone fractures should be investigated completely. It may hide a tumor as a cause.

Hydraulic fracturing is an efficient method to develop oil/gas resources economically. Temporary plugging and diverting fracturing (TPDF) can generate diversion fractures perpendicular to the initial fractures and enhance the stimulated area. The aperture of the diversion fractures determines its conductivity and the oil/gas production. This work established a fluid-solid fully coupled simulation model to investigate the fracture aperture influenced by various factors during TPDF. The factors include the permeability of the tight plug, the length of the tight plug, Young’s modulus, rock tensile strength, in-situ stress contrast, the leak-off coefficient of the fracture surface, and fluid injection rate. Results show that the aperture of the previous fracture can be enlarged, and the aperture of the diversion fracture can be decreased by the tight plug. The aperture at the diversion fracture mouth is much smaller than that along the diversion fracture. Reservoirs with low Young’s modulus and high rock tensile strength can generate the diversion fracture with a wider aperture. Moreover, increasing the fluid injection rate can effectively increase the fracture mouth aperture. In this way, the risk of screenout can be lowered. This work is beneficial for the design of the TPDF and ensures safe construction.

Percutaneous kyphoplasty (PKP) is a highly successful treatment option for Kümmell's disease (KD). Due to the obstruction of the fibrocartilaginous membrane at the periphery of the intervertebral vacuum cleft (IVC) and inadequate osteointegration of conventional bone cement, there is insufficient locking strength between trabecular bone and bone cement in Kümmell's disease (KD), leading to postoperative displacement of the bone cement and sub-sequent early surgical failure. However, there is no standard strategy managing this complica-tion at present. We reported a rare case of premature bone cement displacement resulting in adjacent vertebra fracture. An 80-year-old male with Kümmell's disease at T10 received per-cutaneous kyphoplasty (PKP) with bone cement leaking into the upper disc. Only 3 days after the surgery, the patient complained of severe back pain again. X-ray and MRI showed bone cement displacement at T10, adjacent vertebra fracture at T9. In consideration of poor toler-ance of open surgery for the old patient, we successfully revised by using percutaneous ky-phoplasty with multi-point anchoring technique (A-PKP). During a 10-month postoperative follow-up, the patient reported pain relief. X-ray and three-dimensional CT scan revealed no obvious progress of bone cement displacement. Although the exact mechanism underlying this rare complication remains unclear, we observed that the premature bone cement dis-placement can result in adjacent vertebra fracture especially when the pattern of bone cement is blocky. Percutaneous kyphoplasty with multi-point anchoring technique (A-PKP) appears effective in managing this complication.

This paper presents the results of experiments on the study of a hydraulic fracture interaction with a preliminary created fracture that simulates a natural fracture. A distinctive feature of the conducted experiments is the ability to use an ultrasonic sounding to measure the fracture propagation and opening simultaneously with the fluid pore pressure measurements at the several points of the porous saturated sample. It allows to obtain the pressure distributions at various experiment stages and to establish a relation between the pore pressure distribution and the hydraulic fracture propagation and its interaction with macroscopic natural fracture. The possibilities of active ultrasonic monitoring have been expanded due to preliminary calibration experiments, which make it possible to estimate the fracture opening value by attenuation of ultrasonic pulses. The experiments show that the fracture propagation is limited by the natural fracture. This is caused by the hydraulic fracturing fluid leaks into the natural fracture, so both hydraulic fracture and natural fracture compose united hydraulic system.

The incidence of articular injury, particularly osteochondral fractures (OCF), has seen a notable increase in recent years. Regardless of their location, fragments might be overlooked by plain radiographs which might lead to osteoarthritis in the long run. Diagnostic imaging has a pivotal role in the assessment and classification of the fracture severity, as well as the presence of any associated dislocations. These fractures require surgical intervention for the restoration of joint function and the reduction of long-term complications. The paper aims to present the surgical correction and post-operative treatment of osteochondral fractures with absorbable implants in three children. Affected areas are discussed as follows: lateral condyle of the femur, patella, and radial head. Utilising absorbable implants for the management of OCFs provides numerous advantages, including the elimination of the need for reanaesthesia and reoperation, reducing complications, and enabling early rehabilitation. This approach also minimises the period of hospitalisation and proved effective in pediatric OCF treatment.

The purpose of this study was to compare the long-term clinical outcomes and quality of life measures for two fixation methods in the setting of displaced femoral neck fractures. The two groups included fixation with multiple cancellous screws (group 1) and telescopic femoral neck screws and small locking plate device (Targon FN) (group 2). Patients underwent reduction and internal fixation with either multiple cancellous screws or Targon FN device from March 2000 to January 2012. Failure endpoints included nonunion, osteonecrosis of the femoral head, and revision surgery. Patient reported outcome measures included chronic pain, ability to ambulate, and the use of ambulation assistive devices. Statistical analysis demonstrated a statistically significant lower rate of non-union and overall complication in the Targon FN group (p value < 0.001 and p value = 0.005 respectively). Logistic regression analysis showed that operative fixation with the Targon FN device decreased the odds ratio for overall complication by a factor of 0.34 (P = 0.02). There were no statistically significant differences between groups 1 and 2 in patient reported outcomes (chronic pain (p-0.21), ability to ambulate (p- 0.07), and the use of ambulation assistive device (p-0.07)). When compared to traditional cancellous screw fixation of femoral neck fractures, the Targon FN device has significantly lower complications rates and equivalent patient reported outcomes.

An electrothermal analysis for barium titanate based ceramics is presented combining the Heywang–Jonker model for the electric resistivity with a heat dissipation mechanism based on natural convection and radiation in a one dimensional model on the device level with voltage as the control parameter. Both PTC and NTC effects are accounted for through the double Schottky barriers at the grain boundaries of the material. The problem formulated in this way admits uniform and non–uniform multiple steady state solutions that do not depend on the external circuit. The numerical bifurcation analysis reveals that the PTC effect gives rise to several multiplicites above the Curie point, whereas the NTC effect is responsible for the thermal runaway (temperature blowup). The thermal runaway phenomenon as a potential thermal shock could be among the possible reasons for the observed thermomechanical failures (delamination fracture). The theoretical results for the NTC regime and the thermal runaway are in agreement with experimental flash sintering results obtained for 3% and 8% yttria stabilized zirconia.

Faced with difficulties stemming from the complex interactions between tight gas sand bodies and fractures when describing and identifying reservoirs, a composite reservoir model was established. By setting the supply boundary to characterize the superposition characteristics of sand bodies, a mathematical model of unstable seepage in fractured vertical wells in tight sandstone gas reservoirs was constructed considering the factors such as stress sensitivity, fracture density and fracture symmetry. The seepage law and pressure response characteristics of gas well in tight sandstone discontinuous reservoir with stress sensitivity, semi-permeable supply boundary and complex fracture topology were determined, and the reliability of the model was verified. The research results more accurately depict the pressure characteristic curve of the superposed sand body complex fracture vertical well, and provide a more comprehensive model for tight gas production dynamic analysis and well test data analysis, which can more accurately guide the dynamic inversion of reservoir and fracture parameters.

Osteoporotic vertebral fracture is the most common fracture from osteoporosis, and are largely undiagnosed due to the mostly asymptomatic nature of the condition. It increases the risk of subsequent fractures and contributes to societal burden. Risk factors for osteoporotic fractures are found in the WHO fracture risk assessment model and used as a tool for monitoring bone health. Vertebral fractures are diagnosed from anteroposterior and lateral spine radiographs and are confirmed with an approximate loss of 20% vertebral height as compared to adjacent vertebrae. One of the most used grading for vertebral fractures is the SQ grading. Mild vertebral fractures could easily be misdiagnosed due to some peculiarities of the vertebral column. CT scan is useful for planning surgical intervention while an MRI scan can provide information about the recency of the fracture and rule out cancer-related fractures. Management depends on the severity of the fracture which could range from conservative management to surgical vertebral augmentation and decompression. Bisphosphonates are used to treat osteoporosis in acute and long-term management of fractures. Osteoimmunological therapies such as denosumab and romosozumab are new therapeutic interventions for osteoporosis while there are many other potential treatment options. Precision medicine provides an individualized treatment approach while regenerative medicine utilizes mesenchymal stem cells for fracture repair.

We performed arthroscopically assisted coracoclavicular (CC) stabilization using a suture button device for modified Neer type IIb lateral clavicle fractures accompanied by CC ligament injury. The purpose of the present study was to evaluate the radiological and clinical outcomes of this procedure. Six consecutive patients with modified Neer type IIb fractures were treated with the technique and followed for 12 months. Postoperative ranges of motion (ROMs) and X-rays were evaluated every 3 months. Shoulder functional scores (University of California Los Angeles score, Japanese Orthopedics Association score), visual analog scale (VAS) scores for pain at rest, at night, and during motion, and VAS score for satisfaction were analyzed at 12 months after surgery. For the clinical outcomes, early ROM recovery and excellent outcomes were achieved. For the radiological outcomes, all patients accomplished bone union, slight superior displacement was noted in the CC distance and Dog Bone distance, and bone hole dilation was observed in the superior coracoid and inferior clavicle, but there were no critical complications. The present findings indicate that arthroscopically assisted CC stabilization with a suture button device for unstable lateral clavicle fractures can produce satisfactory radiological and clinical results.

Bone/fracture healing is a complex process with different steps and four basic tissue layers being affected: cortical bone, periosteum, fascial tissue surrounding the fracture, and bone marrow. Stem cells and their derivatives, including embryonic stem cells, induced pluripotent stem cells, mesenchymal stem cells, hematopoietic stem cells, skeletal stem cells, and multipotent stem cells, can function to artificially introduce highly regenerative cells into decrepit biological tissues and augment the healing process at the tissue level. Stem cells are molecularly and functionally indistinguishable from standard human tissues. The widespread appeal of stem cell therapy lies in its potential benefits as a therapeutic technology that, if harnessed, can be applied in clinical settings. This review aims to establish the molecular pathophysiology of bone healing, the current stem cell interventions that disrupt or augment the bone healing process, and finally, consider the future direction/therapeutic options related to stem cells and bone healing.

Leaf springs are critical components for the railway vehicle safety in which they are installed. Although these components are produced in high-strength alloyed steel and designed to operate under cyclic loading conditions in the high-cyclic fatigue region, their failure is still possible to occur and hence lead to economic and human catastrophes. The aim of this document is precisely to characterise the mechanical crack growth behaviour of the 51CrV4 spring steel representative of leaf springs under cyclic conditions, that is, crack propagation in mode I. The common fatigue crack growth prediction models (Paris and Walker) considering the effect of stress ratio and parameters such as propagation threshold, critical stress intensity factor and crack closure ratio are also determined using statistical methods, which resulted in good approximations with respect to the experimental results. Lastly, the fracture surfaces under the different test conditions were analysed using SEM, with no significant differences to declare. As a result of this research work, it is expected that the developed properties and fatigue crack growth prediction models can assist design and maintenance engineers in understanding fatigue behaviour in the initiation and propagation phase of cracks in leaf springs for railway freight wagons.

We present an investigation on the fracture of a mold, comparing it with a normal part using specific techniques, such as EDX, SEM, and AES. The EDX analysis revealed that the composition of the normal part was consistent with that of low carbon steel, mainly comprising Fe and C. In contrast, the fractured part exhibited cracks due to nonconforming nonmetallic inclusions and reticular carbides, with fractures resulting from microporosity agglomeration and cleavage fracture. The SEM and AES analyses further presented the causes of mold fracture, highlighting the mechanism by which dimples on the specimen edge contributed to the fracture. The EDX analysis confirmed that the mold experienced thermal brittleness during use. To enhance mold durability and extend its lifespan, a double-pulse electrodeposition method was employed to create a NiCo alloy coating as a replacement for the Cr layer on the metal surface. The coating exhibited a smooth and scratch-free surface. The prepared NiCo special coating significantly increased the mold yield strength by approximately 313.8%, facilitated a 13% increase in plastic deformation, and reduced fracture strain by 25%, effectively preventing mold fracture and 3improving its service life.

Zirconia-reinforced lithium silicate (ZLS) is utilized as a material for prosthetic tooth crowns, offering enhanced strength compared to other dental glass-ceramics. In this study, we investigate a commercial ZLS material, provided in a fully crystallized form. We examine the effects of an optional post-processing heat treatment on micro-contact damage using controlled indentation tests simulating the primary modes of contact during chewing: axial and sliding. Our findings indicate that the heat treatment does not affect mechanical properties such as the elastic modulus, hardness and indentation fracture toughness. However, it does enhance the resistance to contact damage by fracture and chipping in both axial and sliding modes, as well as the resistance to crack initiation measured from sliding tests. This improvement is attributed to the refinement of the flaw population achieved through the heat treatment. The results are analysed within the framework of contact and fracture mechanics, and the implications for prosthetic dentistry are briefly discussed.

The establishment of an isolation layer in submarine mining has long presented an enduring challenge. In the context of this research, we conducted a similarity simulation test to preliminarily ascertain the interplay between the thickness and extent of the isolation layer. Subsequently, we introduce an innovative approach that integrates fractal theory and the bonded block model (BBM) to simulate undersea isolation layer mining. The validation of this method hinges on on-site borehole scanning and displacement monitoring, which serve to depict the intricate fractal evolution of fractures and predict the optimal thickness of the isolation layer. Our findings affirm the robustness and validity of this method. Evaluation of the fractal dimensions of fractures reveals that a critical threshold of 1.7 exists to prevent structural failure of the isolation layer, while a limit of 1.5 is necessary to avert significant water ingress. Remarkably, the correlation dimension of the settlement time series closely aligns with the fractal dimension of the fractures, underscoring the feasibility of ensuring the safety of isolation layer mining through real-time settlement monitoring.

Hard coatings like Titanium diboride (TiB2) on silicon substrates are used for interconnects. micro-electro-mechanical devices and metallurgical protective coatings were analyzed based on shallow depths of nanoindentation penetration which involves a change in the nature of the contact from Hertzian to Pyramidal both in loading as well as unloading modes. Features like ductile fracture, linear unloading, and the creation of electrical conduction paths were analyzed. These high-precision features are influenced by the thickness and crystalline nature of the films and are significant for device fabrication.

Using numerical software to establish a three-dimensional geological model of shield tunneling through fault fracture zones, considering the synchronous grouting effect at the shield tail, the disturbance of various geotechnical structures in the fault fracture zone under deep burial and high water pressure conditions is studied. According to the comparison between the numerical model analysis results and the on-site inspection results of the entire process of Shiziyang B3 section, synchronous grouting at the shield tail is the main reason for the changes in soil and water pressure in the fault fracture zone area. The soil and water pressure changes strongly during shield tunneling, and the maximum excess pore pressure value occurs when the shield tail passes. When the shield tunneling machine is far away, the soil and water stress shows a downward trend. The impact of synchronous grouting decreases with the increase of tunneling distance. Due to the difference in permeability, the variation law of pore pressure in the fault fracture zone is significantly different from the original rock, leading to a faster increase in pore pressure in the fracture zone area and a wider range of influence.

As one of the typical deposits in Sichuan-Yunnan-Guizhou Pb-Zn metallogenic province, the Daliangzi Pb-Zn deposit has a close genetic relation with the structural system of “black/fracture zone” formed under the action of NWW-approx. EW strike-slip structures in the metallogenic province, but the mechanism of rock and ore-controlling action of the structural system remains unclear. Based on detailed analysis of tectonite-mineralized alteration lithofacies of R1 “black/fracture zone”, the tectonite-mineralized alteration lithofacies zones can be divided into 4 types in succession outward from the Pb-Zn mineralization center, i.e., ① brecciated and stockwork-like Pb-Zn mineralization-complex breccia facies zone, ② stockwork-like Pb-Zn mineralization-simple breccia and cataclasite facies zone, ③ veined pyrite-sulfide-dolomitic cataclasite facies zone, and ④ fine-veined calcite-black carbonized dolomite facies zone; Cl- and SO42--rich high-temperature oxidizing ore-bearing fluid mixes with reducing fluid in Zone ① while migration and precipitation occur in Zone ④. With the evolution of ore-forming fluid, the homogenization temperature decreases from Zone ① to Zone ④, the salinity increases from Zone ① to Zone ② and then decreases to Zones ③ and ④, and the fluid density has little change on the whole; the contents of Zn, Pb, Cu, Ga, Ge, Cd, Ag, and other metallogenic elements, the Zn/Pb ratio, and the CaO/MgO mole ratio decrease gradually from Zone ① to Zone ④; and REE fractionation, calcilization, silicification, and pyritization enhance gradually from Zone ① to Zone ④. This series of changes are the product of diapirism (cryptoexplosion) of strike-slip structures and “black/fracture zone”, among which the second-order structures (F5, F100, and other faults) derived from NWW-approx. EW striking dextral shear-tension faults F1 and F15 control the brecciated and stockwork-like Pb-Zn mineralized complex breccia facies zones and the stockwork-like Pb-Zn mineralized simple breccia and cataclasite facies zones. Therefore, this paper establishes the zoning mode of tectonite-mineralized alteration lithofacies of “black/fracture zone” and proposes that Zones ① and ② are important prospecting criteria. conclusions.

The physical properties of coal reservoirs are the main restrictions to exploration and development of CBM. The study of the physical characteristics of coal reservoirs and their controlling factors is of great significance to the safe and efficient development and utilization of CBM resources in the mining area. The Pingdingshan No. 10 coal mine was chosen for this study because of its better gas production effect at the test wells. The reservoir properties of the main coal seams of the No. 10 coal mine were tested and analyzed to comprehensively evaluate the reservoir properties. The results indicate that (1) The gas content and methane purity of the No. 4 coal seam are significantly higher than the No. 2 seam, and therefore they have better development potential than the No. 2 seam; (2) The average adsorption time of the No. 2 coal seam is less than that of the No. 4 seam, making it easier to reach the peak production capacity of CBM wells in the short term, but is not conducive to long-term stable production of CBM. The Langmuir volume of the No. 2 coal seam samples was significantly greater than for the No. 4 coal seam; however, the No. 4 coal seam contains about three times the amount of gas in the No. 2 seam; (3) All three coal seams have high porosity, which is favorable for large amounts of CBM adsorption and storage. Micropores predominate, transitional pores are less frequent, and a few mesopores occur; macropores are the least common. Samples from the No. 4 seam contained the highest proportion of micropores; (4) Organic pores were common in the all coal samples, with pore diameters not more than 30 µm, mainly concentrated between 50.5 and 1000 nm. Microfractures with aperture less than 70 nm were relatively frequent, mainly in the 50–65 nm range. A large number of the nanoscale microfractures were curved or jagged; (5) Fractures in the No. 2 and No. 4 coal seam samples with widths of 50 nm to 20 µm were more developed, and many were filled with kaolinite, quartz and other minerals; (6) The samples contained mostly layered silicate minerals (kaolinite), with hard granular minerals (quartz) next, and a very small quantity of iron-type minerals such as siderite and pyrite in dendritic form. The results of this study can provide a reference basis for the large-scale development and utilization of subsequent CBM wells.

The integration of three-dimensional (3D) printed resin denture teeth represents a significant ad-vancement in digital dentistry. This study aimed to assess their ability to withstand chipping and indirect tensile fractures, comparing them with conventionally manufactured resin denture teeth. Four groups, each comprising 30 specimens, were examined: Group 1 featured 3D printed denture teeth (NextDent, 3D Systems, Soesterberg, The Netherlands), while the others included commer-cially obtained Ivostar Shade, SpofaDent Plus, and Major Super Lux teeth. Stereolithography 3D printing was utilized to produce methacrylate-based photopolymerized resin teeth models for Group 1, while the remaining groups were commercially sourced. Chipping and indirect tensile fracture tests were performed at a speed of 1 mm/min until fracture occurred. Statistical analysis was conducted using one-way analysis of variance (ANOVA) with Tukey's honestly significant difference multiple comparisons test (p < 0.05). Results indicated that 3D-printed teeth exhibited higher indirect tensile fracture resistance than Major Super Lux and Ivostar Shade but lower than SpofaDent Plus. Additionally, in the chipping test, buccal chipping occurred in 3D-printed resin teeth without distortion. In the indirect tensile test, the fracture line emerged near the loading point, extending cervically from the inner incline of both cusps. Overall, denture teeth produced via 3D printing with printable resin materials demonstrated sufficient fracture resistance, making them suitable for prosthetic applications.

Augmented Reality (AR) and 3D printing (3DP) are novel technologies in the orthopedic field. Over the past decade, enthusiasm for these new digital applications is driving new perspectives in improving diagnostic accuracy and sensitivity in the field of traumatology. Currently, however, it is still difficult to quantify the value and impact in the medical-scientific field especially in the improvement of diagnostic in complex fractures. Acetabulum fractures have always been a challenge among orthopedics, for volumetric complexity and low diagnostic reliability.Background/Objectives: The goal of this study is to determine whether these methods can improve the learning aspect and diagnostic accuracy of complex acetabulum fractures compared to gold standard CT (computed tomography). Methods: Orthopedic residents of our department have been selected and divided into Junior (JUN) and Senior (SEN) groups. Associated fractures of acetabulum have been included in the study, obtaining : CT-scans, 3DP model, and AR model displayed on a tablet screen. In a double-blind questionnaire, each resident classified every fracture according to methods. Diagnostic accuracy (DA), response time (RT), agreement (R), and confidence (C) were measured. Results: 20 residents (JUN=10, SEN=10) classified five fractures. Overall DAs were 26% (CT), 18% (3DP), and 29% (AR). AR-DA resulted to be superior to 3DP-DA (p=0,04). DA means (JUN vs SEN respectively) were :CT-DA was 20% vs 32% (p&lt;0.05), 3DP-DA was 12% vs 24% (p=0.08), and AR-DA was 28% vs 30% (p=0,80). Overall RT was 61.2 sec (±24,6) for CT, 35.8 sec (±20,1) for 3DP, and 46,7 sec (±20,8) for AR. R was fairly poor between methods and groups. 3DPs resulted to have superior overall C (65%). Conclusions: AR resulted to have the same Overall DA as CT, independent from experience, 3DP has minor DA and R, but it resulted to be the most confident and fast method. Intra and interobserver R between methods remain very poor in residents.

Carbon dioxide capture and storage (CCS) is a necessary requirement for high-emitting CO2 industries to significantly reduce volumes of greenhouse gases released to the atmosphere and mitigate the climate change. Geological CO2 storage into depleted oil and gas fields is the fastest and most accessible option for CCS deployment allowing for re-purposing of existing infrastructure and utilizing the significant knowledge about the subsurface acquired during the field production operations. Location of such depleted fields in neighbourhood of high-emitting CO2 industries is additional advantage available for matured on-shore Europe fields. Considering these advantages, the oil and gas operators are now evaluating different possibilities for CO2 sequestration projects for the fields approaching end of production. This article describes an integrated approach to reservoir simulations focused on evaluating CO2 injection pilot at one of such matured fields operated by MND and located in the Czech Republic. The potential CO2 injection site in focus is a naturally fractured carbonate reservoir. This oil-bearing formation has a gas cap at the top and a limited aquifer at the bottom of the reservoir and was produced mainly by pressure depletion with quite limited pressure support from water injection. The article summarizes results of efforts taken by the multi-disciplinary team to develop and apply an integrated approach to reservoir simulation started from geological modelling of the naturally fractured reservoir and integrating results of laboratory studies and their interpretation (geomechanical and geochemistry laboratory experiments) and dynamic field data analysis (pressure transient analysis including time-lapse) into the history matching of the reservoir model and simulations of pilot CO2 injection. Attention is given to evaluating and modelling stress-sensitive fracture properties and safe injection envelope preventing induced fracturing as well as impact of potential salt precipitation in the near wellbore area. These effects are considered in the context of pilot CO2 injection and addressed in reservoir simulations of the injection scenarios. Single porosity and permeability reservoir simulations with dominating fracture flow and black-oil formulation with CO2 simulated as a solvent were used in this study and arguments for such choice of the simulation approach for the site in focus are shortly discussed. The reservoir simulations have indicated larger site injection capacity than required for the pilot injection and allowed to evaluate CO2 migration pathway within the reservoir. The application of the approach to the site in focus has also revealed large uncertainties, related to fracture description and geomechanical evaluations, resulted in an uncertain safe injection envelope. These uncertainties should be addressed in further studies in preparation to the pilot. The article concludes with an overview of the outcomes of the integrated approach and its application to the field in focus including discussion of issues and uncertainties revealed.

In the history of high-performance polymer composite parts with continuous in-plane fibre reinforcement, the comparatively moderate structural-mechanical properties in their out-of- plane-z-direction and the limited load carrying capability between individual reinforcement layers within the laminated structures have always been one of the greatest challenges. Plenty of research work has been carried out to improve load transfer capability as well as fracture toughness for crack opening events between the reinforcement layers by means of out-of-plane fibre reinforcement implementation, for example by sewing or z-pinning technologies. However, the results have not become established across a wide range of applications so far, because the technologies used have led to considerable losses of in-plane strength properties. In this paper first results are presented for a new method of a low fraction z-fibre reinforcement by means of very thin diameter laser drilled holes filled with short carbon fibres, demonstrating potential to improve Mode II fracture toughness.

Hip fractures are the most frequently treated fractures in the world. Of these, intertrochanteric fractures (ITFs) account for almost 50%. After surgical fixation of ITFs, nonunion is rare. Nonunions are commonly produced from mal-reduction (in varus) and/or inadequate stability of the bone-implant construct and/or fatigue failure of the implants. Other causes of nonunion include posteromedial comminution and osteoporosis. The published incidence of ITF nonunion is 1%-2%. Mechanical complications of ITFs include cut-out, excessive shortening of the proximal femur, delayed union, nonunion, early implant fracture, nail toggle and cut through/medial migration. That is why a fundamental goal in the treatment of ITFs is to achieve stable fixation in osteoporotic bone, allowing early weight bearing. Intraoperative determination of fracture stability is essential. The American Academy of Orthopedic Surgeons (AAOS) clinical practice guidelines for the management of intertrochanteric fractures (ITF) in patients older than 55 years are the following: 1) In patients with stable ITF, the use of either a sliding hip screw (SHS) or a cephalomedullary nail (CMN) is advised (strong strength of evidence). 2) In patients with reverse obliquity fractures, a CMN is recommended (strong strength of evidence). 3) Patients with unstable ITF should be treated with a CMN (strong strength of evidence). 4) In patients with ITF, a short or long CMN may be considered (limited strength of evidence).