Operative vs nonoperative treatment of displaced intraarticular calcaneal fracture: A meta-analysis of randomized controlled trials

AIM: To investigate clinical efficacy of displaced intraarticular calcaneal fracture(DIACF) following operation and nonoperation. METHODS: Literature search was performed of Pub Med and Cochrane Library by two independent authors to identify randomized controlled trials(RCTs) comparing operative vs nonoperative treatment of DIACF from inception to December 31 st, 2013. RCT quality was evaluated by the modified Jadad scale. Dichotomous variables were pooled using risk ratios by review manager 5.3 software. Fixed-effects or randomeffects models were adopted with P > 0.05 or P ≤ 0.05 for heterogeneity tests, respectively.RESULTS: Eight RCTs comprising 767 cases met inclusion criteria. Results revealed that more surgically treated patients could resume pre-injury job(P = 0.006). No statistical differences were found between the two groups in residual pain(P = 0.33), shoe fitting problems(P = 0.07), limited walking distance(P = 0.56) or secondary late arthrodesis(P = 0.38). However, operative treatment was associated with a higher complication rate(P = 0.003). Subgroup analyses of specific complications revealed that except for a higher risk of superficial wound problems(P < 0.0001) in operative group, the two groups had similar complication rate in deep wound infection(P = 0.34),compartment syndrome(P = 0.46), thromboembolism(P = 0.32), reflex sympathetic dystrophy(P = 0.51) or traumatic arthritis secondary to DIACF(P = 0.43).CONCLUSION: Current evidence demonstrates that compared with operative treatment, conservative treatment of DIACF lead to similar clinical outcomes regarding residual pain, shoe fitting, walking distance and secondary subtalar arthrodesis but a significantly lower complication rate.

Humeral head replacement and individualized rehabilitation for displaced four-part fractures of proximal humerus

Objective To investigate the clinical outcome of humeral head replacement and individualized rehabilitation for displaced four-part fractures of proximal humerus,to provide clinical guideline of treating complicated fractures of

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.

APPLICATION OF SINTAP TO THE SAFETY ASSESSMENT OF X65 PIPELINE STEEL

The recently developed European flaw assessment procedure, structural integrity assessment procedure（SiNTAP） is applied to assessment for welded joints of the API 5L X65 pipeline steel with an assumed embedded flaw and surface flaw at the weld toe. As one of the basic input data, fracture toughness crack tip opening displacement （CTOD） tests are conducted at 0℃ and performed according to the requirements of the standard of BS7448. For the heat affected zone （HAZ） specimens, the microstructure observation is performed to insure that the tip of the crack is located in the coarse grain zone. The result explains the dispersity of the test values. In structural integrity assessment procedure-fracture assessment diagram（SINTAP FAD） method, the failure curves of welded joints at level 1 and 3 are derived from the tensile test results. The results of the assessment show that all assessment points are located within the failure lines of analysis level 1 and 3. So the welded joint of the pipeline is safe. This study laid the foundation of application of SINTAP to pipeline structure assessment.