3D Physical Simulation of Water Flooding Characteristics of Buried Hill Reservoir with Different Fracture Systems

In order to understand the water-flooding characteristics of different fracture systems in metamorphic rock buried hill reservoirs and the mechanism of improving water-flooding development effect, a three-dimensional physical model of fractured reservoirs is established according to the similarity criterion based on the prototype of metamorphic buried hill reservoirs in JZ Oilfield in Bohai Bay Basin. Combined with the fractured reservoir characteristics of JZ Oilfield, the water displacement characteristics of the top-bottom staggered injection-production well pattern in different fracture network mode and different fracture development degree of buried hill reservoir are studied. The experimental results show that: 1) the more serious the fracture system irregularity is, the shorter the water-free oil production period is and the lower the water-free oil recovery is. After water breakthrough of production wells, the water cut rises faster, and the effect of water flooding development is worse;2) under the condition of non-uniform fracture development, the development effect of the bottom fracture undeveloped is better than that of the middle fracture undeveloped. Water injection wells are deployed in areas with relatively few fractures, while oil wells are deployed in fractured areas with higher oil recovery and better development effect.

A Study on Propagation Mechanism of Fracture Systems in Rock Masses by Discontinuity Displacement Method

The main task of fracture mechanics of rock masses is the study on the propagating mechanism of fractures in rock masses , which can be efficiently conducted by discontinuty displacement (DD) numerical evaluation . Firstly ,the element stress and displacement are analysed and the principle and steps of the numerical calculation of stress intensity factor and fracture extension force are introduced .The numerical results of parallel and echelon fracture systems ,which are compared with real field fractures .are presented. Finally . a simple engineering application example is presented .

Interaction among fractures and stress field computation of fracture systems

The interaction problem among fractures under the action of compressional stress is studied in this paper by using the finite element method and boundary element method respectively.The mechanical criteria which differentiate between the independent fractures and fracture systems and their computation methods are presented in this paper.The proportional conditions between length and spacing of fractures that exist interaction for several kinds of fracture groups of different geometric arrangement are given.The effect of interaction among fractures on the displacement field,stress field and strain energy distribution are computed.The relations between the fracture system of conjugate array and conjugate earthquakes are also discussed in this paper.

Characterization of Complex Fracture System in Volume Fracturing of Shale Gas Reservoir

After volume fracturing of horizontal wells in shale gas reservoir, an extremely complex fracture system is formed. The space area of the fracture system is the reservoir reconstruction volume of shale gas reservoir. The geometric parameters such as crack length, crack width, crack height, and characteristic parameters such as crack permeability and fracture conductivity proposed for a single crack in conventional fracturing are insufficient to describe and characterize the complex network fracture system after volume fracturing. In this paper, the discrete fracture modeling method is used to establish the volume fracturing network fracture model of horizontal wells in shale gas reservoir by using the random modeling method within the determined reservoir space. The model is random and selective, and can fully provide different forms of volume fracturing fracture expansion, such as conventional fracture morphology, line network model and arbitrarily distributed network fractures. The research results provide a theoretical basis for the development plan and stimulation plan of shale gas reservoir, and have important reference value and significance for other unconventional gas reservoir fracturing.

Systemic modulation of skeletal mineralization by magnesium implant promoting fracture healing: Radiological exploration enhanced with PCA-based machine learning in a rat femoral model

The clinical application of magnesium(Mg)and its alloys for bone fractures has been well supported by in vitro and in vivo trials.However,there were studies indicating negative effects of high dose Mg intake and sustained local release of Mg ions on bone metabolism or repair,which should not be ignored when developing Mg-based implants.Thus,it remains necessary to assess the biological effects of Mg implants in animal models relevant to clinical treatment modalities.The primary purpose of this study was to validate the beneficial effects of intramedullary Mg implants on the healing outcome of femoral fractures in a modified rat model.In addition,the mineralization parameters at multiple anatomical sites were evaluated,to investigate their association with healing outcome and potential clinical applications.Compared to the control group without Mg implantation,postoperative imaging at week 12 demonstrated better healing outcomes in the Mg group,with more stable unions in 3D analysis and high-mineralized bridging in 2D evaluation.The bone tissue mineral density(TMD)was higher in the Mg group at the non-operated femur and lumbar vertebra,while no differences between groups were identified regarding the bone tissue volume(TV),TMD and bone mineral content(BMC)in humerus.In the surgical femur,the Mg group presented higher TMD,but lower TV and BMC in the distal metaphyseal region,as well as reduced BMC at the osteotomy site.Principal component analysis(PCA)-based machine learning revealed that by selecting clinically relevant parameters,radiological markers could be constructed for differentiation of healing outcomes,with better performance than 2D scoring.The study provides insights and preclinical evidence for the rational investigation of bioactive materials,the identification of potential adverse effects,and the promotion of diagnostic capabilities for fracture healing.

Identifying flow regime in the aquifer of fractured rock system in Germi Chai Basin,Iran

Considering the importance of fractured rock aquifers in the hydrogeologic process,this research aimed to analyze the flow regime,internal degree of karstification,and estimate storage volume in fractured rock aquifers of the Germi Chai Basin in northwest Iran,which is attributed to its active tectonics,erosion,and the lithological diversity.Given the geological setting,the hypothesis is that this basin is characterized by a high degree of karstification and diffuse or intermediate flow regime leading to variation in discharge flow rate.The hydrodynamic and hadrochemical analysis was conducted on 9 well distributed springs across the basin from 2019 to 2020.The maximum flow rate in most of the springs appeared in the early wet season despite their different levels of fluctuations on the monthly discharge time series.Analyzing the spring recession curve form revealed an aquifer containing multiple micro-regimes withαrecession coefficients and a degree of karstification ranging between 0.001 to 0.06 and 0.55 to 2.61,respectively.These findings indicated a dominant diffuse and intermediate flow system resulting from the development of a high density of fractures in this area.The electrical conductivity of the spring changes inversely proportional to the change in flow discharge,indicating the reasonable hydrological response of the aquifer to rainfall events.Hydrograph analysis revealed that the delay time of spring discharge after rainfall events mostly varies between 10 to 30 days.The total dynamic storage volume of the spring for a given period(2019-2020)was estimated to be approximately 1324 million cubic meters reflecting the long-term drainage potential and high perdurability of dynamic storage.Estimating the maximum and minimum ratio revealed that the springs recharging system in Germi Chai Basin comes under the slow aquifers category.This finding provides valuable insight into the hydrogeological properties of fractured rock aquifers contributing to effective water management strategy.

Clinical effect of operative vs nonoperative treatment on humeral shaft fractures:Systematic review and meta-analysis of clinical trials

BACKGROUND Whether operation is superior to non-operation for humeral shaft fracture remains debatable.We hypothesized that operation could decrease the nonunion and reintervention rates and increase the functional outcomes.AIM To compare the clinical efficacy between operative and nonoperative approaches for humeral shaft fractures.METHODS We searched the PubMed,Web of Science,ScienceDirect,and Cochrane databases from 1990 to December 2023 for clinical trials and cohort studies comparing the effects of operative and conservative methods on humeral shaft fractures.Two investigators independently extracted data from the eligible studies,and the other two assessed the methodological quality of each study.The quality of the included studies was assessed using the Cochrane risk bias or Newcastle-Ottawa Scale.The nonunion,reintervention and the overall complications and functional scores were pooled and analyzed using Review Manager software(version 5.3).RESULTS A total of four randomized control trials and 13 cohort studies were included,with 1285 and 1346 patients in the operative and nonoperative groups,respectively.Patients in the operative group were treated with a plate or nail,whereas those in the conservative group were managed with splint or functional bracing.Four studies were assessed as having a high risk of bias,and the other 13 were of a low risk of bias according to the Newcastle-Ottawa Scale or Cochrane risk bias tool.The operative group had a significantly decreased rate of nonunion[odds ratio(OR)0.30;95%CI:0.23 to 0.40,reintervention(OR:0.33;95%CI:0.24 to 0.47),and overall complications(OR:0.62;95%CI:0.49 to 0.78)].The pooled effect of the Disabilities of Arm,Shoulder,and Hand score showed a significant difference at 3[mean difference(MD)-8.26;95%CI:-13.60 to-2.92],6(MD:-6.72;95%CI:-11.34 to-2.10),and 12 months(MD:-2.55;95%CI:-4.36 to-0.74).The pooled effect of Visual Analog Scale scores and the Constant-Murley score did not significantly differ between the two groups.CONCLUSION This systematic review and meta-analysis revealed a trend of rapid functional recovery and decreased rates of nonunion and reintervention after operation for humeral shaft fracture compared to conservative treatment.

Progress of systematic psychological interventions in elderly patients with femoral fractures:A comprehensive review

This review aims to gain a deeper understanding of the psychological state of elderly patients with femoral fractures and provide more theoretical and practical support for clinical treatment and care.Through a literature analysis,we found that elderly patients with femoral fractures face various psychological issues such as anxiety,depression,sleep disorders,and social isolation.The application of systematic nursing interventions in clinical practice,including cognitivebehavioral therapy,mindfulness therapy,family therapy,art therapy,interpersonal therapy,emotion-focused therapy,and relaxation training,has yielded significant results.Systematic psychological interventions can improve the psychological state and quality of life of elderly patients with femoral fractures.Therefore,promoting the application and practice of systematic psychological interventions in the clinical care of elderly patients with fractures will provide more effective psychological services to a wider group of patients with fractures in the future.

Meta-analysis of the clinical efficacy of the Gamma3 nail vs Gamma3U-blade system in the treatment of intertrochanteric fractures

BACKGROUND The traditional Gamma3 nail is a mainstream treatment for femoral intertrochanteric fractures.Literature reports that the Gamma3U-blade system can increase the stability of the Gamma3 nail and reduce complication incidence.However,comparative studies between the Gamma3U-blade and Gamma3 systems are limited;hence,this meta-analysis was performed to explore the clinical efficacy of these two surgical methods.AIM To investigate the clinical efficacy of Gamma3 and Gamma3 U-blade for intertrochanteric fractures.METHODS A computerized search for Chinese and English literature published from 2010 to 2022 was conducted in PubMed,Cochrane,CNKI,Wanfang,and VIP databases.The search keywords were gamma 3,gamma 3 U blade,and intertrochanteric fracture.Additionally,literature tracking was performed on the references of published literature.The data were analyzed using Revman 5.3 software.Two individuals checked the inputs for accuracy.Continuous variables were described using mean difference and standard deviation,and outcome effect sizes were expressed using ratio OR and 95%confidence interval(CI).High heterogeneity was considered at(P<0.05,I2>50%),moderate heterogeneity at I2 from 25%to 50%,and low heterogeneity at(P≥0.05,I2<50%).RESULTS Following a comprehensive literature search,review,and analysis,six articles were selected for inclusion in this study.This selection comprised five articles in English and one in Chinese,with publication years spanning from 2016 to 2022.The study with the largest sample size,conducted by Seungbae in 2021,included a total of 304 cases.Statistical analysis:A total of 1063 patients were included in this meta-analysis.The main outcome indicators were:Surgical time:The Gamma3U blade system had a longer surgical time compared to Gamma3 nails(P=0.006,I2=76%).Tip-apex distance:No statistical significance or heterogeneity was observed(P=0.65,I2=0%).Harris Hip score:No statistical significance was found,and low heterogeneity was detected(P=0.26,I2=22%).Union time:No statistical significance was found,and high heterogeneity was detected(P=0.05,I2=75%).CONCLUSION Our study indicated that the Gamma3 system reduces operative time compared to the Gamma3 U-blade system in treating intertrochanteric fractures.Both surgical methods proved to be safe and effective for this patient group.These findings may offer valuable insights and guidance for future surgical protocols in hip fracture patients.

Functional Outcomes of Adult Tibia Shaft Fractures Treated with Solid Intramedullary Nails versus Hollow Nails: A Systematic Review

Introduction: The management of fractures of the tibia shaft is an important aspect of orthopaedic care, and the selection of the surgical method for fixation can substantially impact patient outcomes. The current review aims to compare the outcomes of adult tibia fractures treated with solid nails to those treated with hollow nails. Methods: A search on Scopus, PubMed, and Cochrane Library, using three keywords (Outcome, Tibia shaft fractures, Nail) was conducted in April 2023. Results were compiled and two independent reviewers screened and selected eligible articles After removing duplicates, titles and abstracts were read to exclude ineligible studies. Full-text articles of the remaining papers were read to select eligible studies which were further critically appraised to ascertain their methodological quality. The data extracted from the selected papers were synthesized using a combination of pooling of results, tests of statistical difference (t-test and chi-square) and narrative synthesis methods. Results: A total of 2295 articles were obtained from the databases and citation searching. A total of 9 papers were identified as eligible and included in the review. Findings revealed that there is no statistical difference in the outcomes of tibia fractures treated with either solid or hollow nail groups such as duration of surgery (p = 0.541), rate of delayed and non-union (p = 0.342), and rate of surgical site infections (p = 0.395). Conclusion: Intramedullary nailing of tibia shaft fractures with either solid or hollow nails have similar functional outcomes.

Pulp health and calcific healing of a complicated crown–root fracture with additional root fracture in a maxillary incisor: A case report

BACKGROUND Complicated crown–root fracture (CRF) involves severe injury to the crown, root,and pulp, and may be accompanied by multiple root fractures. The loss of a toothhas lifelong consequences for children and teenagers, but the maintenance of pulphealth and the calcific healing of multiple root fractures are rarely reported in theliterature.CASE SUMMARY This case reports healing of a permanent tooth with complicated crown–root andadditional root fractures, in which pulp health was maintained. A 10-year-old girlfell and fractured the root of her maxillary left central incisor at the cervical level.After the coronal fragment was repositioned, the tooth was splinted until thetooth was no longer mobile, 2 years later. Eight years after treatment, the toothhas remained asymptomatic with vital pulp and localized gingival overgrowth.Cone-beam computed tomography revealed not only calcified healing of the CRFbut also spontaneous healing in an additional undiagnosed root fracture. Thefracture line on the enamel could not be healed by hard tissue and formed agroove in the cervical crown. It was speculated that the groove was related to thelocalized gingival overgrowth.CONCLUSION This case provides a clinical perspective of the treatment of a tooth with acomplicated CRF and an additional root fracture.

Prediction of Fracture-Cavity System in Carbonate Reservoir： A Case Study in the Tahe Oilfield

The carbonate rocks in Tahe oilfield, which suffered from multi-period polycycle karstification and structure deformation, are heterogeneous reservoirs that are rich in pores, cavities,and fractures. The reservoirs are diversified in scale, space configuration, and complex in filling. For this kind of reservoir, a suite of seismic prestack or poststack prediction techniques has been developed based on the separation of seismic wave fields. Through cross-verification of the estimated results,a detailed description of palaeogeomorphology and structural features such as pores, cavities, and fractures in unaka has been achieved, the understanding of the spatial distribution of reservoir improved.

Changing trends in the mortality rate at 1-year post hip fracture-a systematic review

BACKGROUND Traditionally, the mortality rate at 1-year post hip fracture was quoted as approximately 30% of all hip fractures. There have been recent improvements in hip fracture care in the main driven by national hip fracture registries with reductions in 30-d mortality rates reported.AIM To address recent 1-year post hip fracture mortality rates in the literature.METHODS Systematic literature review, national hip fracture registries/databases, local studies on hip fracture mortality, 5 years limitation(2013-2017), cohorts > 100,studies in English. Outcome measure: Mortality rate at 1-year post hip fracture.RESULTS Recent 1-year mortality rates were reviewed using the literature from 8 National Registries and 36 different countries. Recently published 1-year mortality rates appear lower than traditional figures and may represent a downward trend.CONCLUSION There appears to be a consistent worldwide reduction in mortality at 1-year post hip fracture compared to previously published research. Globally, those which suffer hip fractures may currently be benefiting from the results of approximately 30 years of national registries, rigorous audit processes and international collaboration. The previously quoted mortality rates of 10% at 1-mo and 30% at 1-year may be outdated.

Virtual Reconstruction of Long Bone Fracture in Car-to-pedestrian Collisions Using Multi-body System and Finite Element Method

Lower limb injures are frequently observed in passenger car traffic accidents.Previous studies of the injuries focus on long bone fractures by using either cadaver component tests or simulations of the long bone kinematics,which lack in-depth study on the fractures in stress analysis.This paper aims to investigate lower limb impact biomechanics in real-world car to pedestrian accidents and to predict fractures of long bones in term of stress parameter for femur,tibia,and fibula.For the above purposes,a 3D finite element(FE) model of human body lower limb(HBM-LL) is developed based on human anatomy.The model consists of the pelvis,femur,tibia,fibula,patella,foot bones,primary tendons,knee joint capsule,meniscus,and ligaments.The FE model is validated by comparing the results from a lateral impact between simulations and tests with cadaver lower limb specimens.Two real-world accidents are selected from an in-depth accident database with detailed information about the accident scene,car impact speed,damage to the car,and pedestrian injuries.Multi-body system(MBS) models are used to reconstruct the kinematics of the pedestrians in the two accidents and the impact conditions are calculated for initial impact velocity and orientations of the car and pedestrian during the collision.The FE model is used to perform injury reconstructions and predict the fractures by using physical parameters,such as von Mises stress of long bones.The calculated failure level of the long bones is correlated with the injury outcomes observed from the two accident cases.The reconstruction result shows that the HBM-LL FE model has acceptable biofidelity and can be applied to predict the risk of long bone fractures.This study provides an efficient methodology to investigate the long bone fracture suffered from vehicle traffic collisions.

Return to sport following tibial plateau fractures: A systematic review

AIM To systemically review all studies reporting return to sport following tibial plateau fracture, in order to provide information on return rates and times to sport, and to assess variations in sporting outcome for different treatment methods.METHODS A systematic search of CINAHAL, Cochrane, EMBASE, Google Scholar, MEDLINE, PEDro, Scopus, SPORTDiscus and Web of Science was performed in January 2017 using the keywords "tibial", "plateau", "fractures", "knee", "athletes", "sports", "non-operative", "conservative", "operative", "return to sport". All studies which recorded return rates and times to sport following tibial plateau fractures were included. RESULTS Twenty-seven studies were included: 1 was a randomised controlled trial, 7 were prospective cohort studies, 16 were retrospective cohort studies, 3 were case series. One study reported on the outcome of conservative management(n = 3); 27 reported on the outcome of surgical management(n = 917). Nine studies reported on Open Reduction Internal Fixation(ORIF)(n = 193), 11 on Arthroscopic-Assisted Reduction Internal Fixation(ARIF)(n = 253) and 7 on Frame-Assisted Fixation(FRAME)(n = 262). All studies recorded "return to sport"rates. Only one study recorded a "return to sport" time. The return rate to sport for the total cohort was 70%. For the conservatively-managed fractures, the return rate was 100%. For the surgically-managed fractures, the return rate was 70%. For fractures managed with ORIF, the return rate was 60%. For fractures managed with ARIF, the return rate was 83%. For fractures managed with FRAME was 52%. The return rate for ARIF was found to be significantly greater than that for ORIF(OR 3.22, 95%CI: 2.09-4.97, P < 0.001) and for FRAME(OR 4.33, 95%CI: 2.89-6.50, P < 0.001). No difference was found between the return rates for ORIF and FRAME(OR 1.35, 95%CI: 0.92-1.96, P = 0.122). The recorded return time was 6.9 mo(median), from a study reporting on ORIF.CONCLUSION Return rates to sport for tibial plateau fractures remain limited compared to other fractures. ARIF provides the best return rates. There is limited data regarding return times to sport. Further research is required to determine return times to sport, and to improve return rates to sport, through treatment and rehabilitation optimisation.

Systematic review of dynamization vs exchange nailing for delayed/non-union femoral fractures

AIM To analyze the literature on efficacy of dynamamization vs exchange nailing in treatment of delayed and nonunion femur fractures.METHODS Ultimately, 31 peer-reviewed articles with 644 exchanged nailing patients and 131 dynamization patients were identified and analyzed. The following key words were inputted in different combinations in order to search the field of publications in its entirety: "nonunion", "delayed union", "ununited", "femur fracture", "femoral fracture", "exchange nailing", "dynaiz(s)ation", "secondary nailing", "dynamic", "static", and "nail revision". The initial search yielded over 150 results, and was refined based on the inclusion criteria: Only studies reporting on humans, non-unions and delayed unions, and the usage of exchange nailing and/or dynamization as a secondary treatment after failed IM nailing. The resulting 66 articles were obtained through online journal access. The results were filtered further based on the exclusion criteria: No articles that failed to report overall union rates, differentiate between success rates of their reported techniques, or articles that analyzed less than 5 patients. RESULTS Exchange nailing lead to fracture union in 84.785% of patients compared to the 66.412% of dynamization with statistically comparable durations until union(5.193 ± 2.310 mo and 4.769 ± 1.986 mo respectively). Dynamically locking exchange nails resulted in an average union time of 5.208 ± 2.475 mo compared to 5.149 ± 2.366 mo(P = 0.8682) in statically locked exchange nails. The overall union rate of the two procedures, statically and dynamically locked exchange nailing yielded union rates of 84.259% and 82.381% respectively. Therefore, there was no significant difference between the different locking methods of exchange nailing for union rate or time to union at a significance value of P < 0.05. The analysis showed exchange nailing to be the more successful choice in the treatment of femoral non-unions in respect to its higher success rate(491/567 EN, 24/57 dynam, P < 0.0001). However, there was no significant difference between the success rates of the two procedures for delayed union fractures(25/27 EN, 45/55 dynam, P = 0.3299). Nevertheless, dynamization was more efficient in the treatment of delayed unions(at rates comparable to exchange nailing) than in the treatment of non-unions.CONCLUSION In conclusion, after examination of factors, dynamization is recommended treatment of delayed femur fractures, while exchange nailing is the treatment of choice for non-unions.

Analysis of the visible fracture system of coalseam in Chengzhuang Coalmine of Jincheng City,Shanxi Province

In No. 3 coalseam of Chengzhuang Coalmine of Jincheng City, there exists the visible fracture system consisting of joints, gas-expanding fractures and cleats. The gas-expanding fractures develop mainly in the bright coal sub-layer and cleats, in the vitrain and bright coal. The joints fall into two types, one developing in the coalseam and the other cutting through the whole coalseam and entering into the top and bottom rock layer. The development direction of joints is basically similar to that of gas-expanding fractures: NNE and NNW. The formation of the visible fracture system is classified as the stage of the development of cleat fissures in the coalification period, the stage of the full development of cleats and the formation of gas-expanding fractures in the second coalification period and the stage of the formation of joints by structural function. There is the spatial unhomoge-neity in three dimensions for the visible fracture system of the coal seam in Chengzhuang Coalmine: the regular distribution of the visible fractures as groups in the plane and the coal sub-layer with high permeability rate in profile. The research findings of the visible fracture system of coal seam can be applied to the drilling of the coalbed methane and to heightening the let-off efficiency of coalseam gas.

Efficacy of the femoral neck system in femoral neck fracture treatment in adults: A systematic review and meta-analysis

BACKGROUND Controversy remains around the available choices for the internal fixation of a femoral neck fracture.The femoral neck system(FNS)was developed in 2018 and has been widely applied since then as it can provide rigid fixation stability with less damage to the bone mass around the fracture.However,no systematic reviews and meta-analyses have investigated the efficacy of the FNS in comparison with that of traditional internal fixation in the treatment of femoral fractures.AIM To assess the efficacy of the FNS in comparison with that of cannulated compression screws(CCS)in the treatment of femoral fractures through systematic review and meta-analysis.METHODS Five electronic databases(PubMed,Embase,Cochrane Central Register of Controlled Trials,China National Knowledge Infrastructure,and Wanfang)were searched from the earliest publication date to December 31,2021.Reference Citation Analysis(https://www.referencecitationanalysis.com/)was used to check the results and further analyze the related articles.Controlled trials were included if the FNS was applied for the femoral neck fracture in adults and if it was compared with CCS for the achievement of internal fixation.The measurement outcomes included the required operation time,observed patient’s blood loss,extent of fracture healing,patient’s Harris Hip score(HHS)at the last follow-up,and records of any complications(such as failure of internal fixation,femoral neck shortness,avascular necrosis of the femoral head,and delayed union or nonunion).RESULTS Ten retrospective controlled studies(involving 711 participants)were included in this metaanalysis.The meta-analysis showed that compared with CCS,use of the FNS could not decrease the operation time[standardized mean difference(SMD):-0.38,95%confidence interval(CI):-0.98 to 0.22,P=0.21,I2=93%),but it could increase the intraoperative blood loss(SMD:0.59,95%CI:0.15 to 1.03,P=0.009,I2=81%).The pooled results also showed that compared with CCS,the FNS could better promote fracture healing(SMD:-0.97,95%CI:-1.65 to-0.30,P=0.005,I2=91%),improve the HHS at the last follow-up(SMD:0.76,95%CI:0.31 to 1.21,P=0.0009,I2=84%),and reduce the chances of developing femoral neck shortness(OR:0.29,95%CI:0.14 to 0.61,P=0.001,I2=0%)and delayed union or nonunion(OR:0.47,95%CI:0.30 to 0.73,P=0.001;I2=0%)in adult patients with femoral neck fractures.However,there was no statistically significant difference between the FNS and CCS in terms of failure of internal fixation(OR:0.49,95%CI:0.23 to 1.06,P=0.07,I2=0%)and avascular necrosis of the femoral head(OR:0.46,95%CI:0.20 to 1.10,P=0.08,I2=0%).CONCLUSION Compared with CCS,the FNS could decrease the chances of developing femoral neck shortness and delayed union or nonunion in adults with femoral neck fractures.Simultaneously,it could accelerate fracture healing and improve the HHS in these patients.

Comparison of the modified Wiltse’s approach with spinal minimally invasive system and traditional approach for the therapy of thoracolumbar fracture

Thoracolumbar fractures are usually treated by open posterior pedicle screw fixation.However,this procedure involves massive paraspinal muscle stripping,inflicting surgical trauma,and prolonged X-ray exposure.In this study,we observed 127 patients with single-segment injury thoracolumbar fractures.Thirty-six patients were treated by the modified Wiltse’s paraspinal approach with minimally invasive channel system,while 91 patients were treated via traditional posterior approach.Operation time,intraoperative blood loss,intraoperative fluoroscopy frequency,screw placement accuracy,visual analogue scale score,and Cobb’s angle of two groups were compared.The X-ray exposure times were notably reduced(4.2±1.6) in the new approach group(P<0.05).The pedicle screw placement accuracy and Cobb’s angle after surgery were similar in the two groups.We conclude that modified Wiltse’s paraspinal approach w ith spinal minimally invasive channel system surgery can significantly reduce the X-ray exposure times and is an alternative therapy for the thoracolumbar fracture.

Operative vs non-operative management of displaced proximal humeral fractures in the elderly: A systematic review and meta-analysis of randomized controlled trials

AIM: To perform a systematic review and meta-analysis comparing operative vs non-operative treatment of displaced proximal humerus fractures in elderly patients.METHODS: A systematic literature search was performed using EMBASE and MEDLINE through the OVID interface,CINAHL,the Cochrane Central Register of Controlled Trials(CENTRAL),Proquest,Web of Science,SAE digital library,and Transportation Research Board's TRID database.Searches of conference proceedings were also conducted.All available randomized controlled trials comparing operative vs non-operative management of displaced three- and four-part proximal humerus fractures in elderly patients were included.The primary outcomes measures included physical function,pain,health related quality of life,mortality,and the re-operation rate.RESULTS: Six randomized controlled trials(n = 287) were included.There was no statistically significant difference in function(MD = 1.72,95%CI:-2.90-6.34,P = 0.47),as measured by the Constant score,between the operative and the non-operative treatment groups.There was no statistically significance difference insecondary outcomes of health related quality of life(standardized MD = 0.27,95%CI:-0.05-0.59,P = 0.09),and mortality(relative risk 1.29,95%CI: 0.50-3.35,P = 0.60).Operative treatment had a statistically significant higher re-operation rate(relative risk 4.09,95%CI: 1.50-11.15,P = 0.006),and statistically significant decreased pain(MD = 1.26,95%CI: 0.02-2.49,P = 0.05).CONCLUSION: There is moderate quality evidence to suggest that there is no difference in functional outcomes between the two treatments.Further high quality randomized controlled trials are required to determine if certain subgroup populations benefit from surgical management.