Pelvic fractures in blunt trauma patients:A comparative study

BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones.Presence of contrast blush(CB)on computed tomography in patients with PF is considered a sign of active bleeding,however,its clinical significance and association with outcomes is debatable.AIM To analyze polytrauma patients with PF with a focus on the geriatric population,co-injuries and the value of contrast blush.METHODS This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center(01/2017-01/2023).Analyzed variables included:Age,sex,mechanism of injury(MOI),injury severity score(ISS),Glasgow coma scale(GCS),abbreviated injury scale(AIS),co-injuries,transfusion requirements,pelvic angiography,embolization,laparotomy,orthopedic pelvic surgery,intensive care unit and hospital lengths of stay,discharge disposition and mortality.The study compared geriatric and non-geriatric patients,patients with and without CB and abdominal co-injuries.Propensity score matching was implemented in comparison groups.RESULTS PF comprised 4%of all trauma admissions.89 patients had CB.286(52%)patients had concomitant injuries including 93(17%)patients with abdominal co-injuries.Geriatric patients compared to non-geriatric had more falls as MOI,lower ISS and AIS pelvis,higher GCS,less abdominal co-injuries,similar CB and angio-embolization rates,less orthopedic pelvic surgeries,shorter lengths of stay and higher mortality.After propensity matching,orthopedic pelvic surgery rates remained lower(8%vs 19%,P<0.001),hospital length of stay shorter,and mortality higher(13%vs 4%,P<0.001)in geriatric patients.Out of 89 patients with CB,45(51%)were embolized.After propensity matching,patients with CB compared to without CB had more pelvic angiography(71%vs 12%,P<0.001),higher embolization rates(64%vs 22%,P=0.02)and comparable mortality.CONCLUSION Half of the patients with PF had concomitant co-injuries,including abdominal co-injuries in 17%.Similarly injured geriatric patients had higher mortality.Half of the patients with CB required an embolization.

Numerical Analysis of Three-Layer Deep Tunnel Composite Structure

To date,with the increasing attention of countries to urban drainage system,more and more regions around the world have begun to build water conveyance tunnels,sewage pressure deep tunnels and so on.However,the sufficient bearing capacity and corrosion resistance of the structure,which can ensure the actual service life and safety of the tunnel,remain to be further improved.Glass Fiber Reinforced Plastics(GFRP)pipe,with light weight,high strength and corrosion resistance,has the potential to be applied to the deep tunnel structure.This paper proposed a new composite structure of deep tunnel lined with GFRP pipe,which consisted of three layers of concrete segment,cement paste and GFRP pipe.A new pipe-soil spring element model was proposed for the pipesoil interaction with gaps.Based on the C3D8R solid model and the Combin39 spring model,the finite element numerical analysis of the internal pressure status and external pressure stability of the structure was carried out.Combined with the checking calculation of the theoretical formula,the reliability of the two finite element models was confirmed.A set of numerical analysis methods for the design and optimization of the three-layer structure was established.The results showed that from the internal GFRP pipe to the outer concrete pipe,the pressure decreased from 0.5 to 0.32 MPa,due to the internal pressure was mainly undertaken by the inner GFRP pipe.The allowable buckling pressure of GFRP pipe under the cover of 5 GPa high modulus cement paste was 2.66 MPa.The application of GFRP pipe not only improves the overall performance of the deep tunnel structure but also improves the construction quality and safety.The three-layer structure built in this work is safe and economical.