Teriparatide anabolic therapy as potential treatment of type Ⅱ dens non-union fractures

Odontoid fractures account for 5% to 15% of all cervical spine injuries and 1% to 2% of all spine fractures. Type Ⅱ fractures are the most common fracture pattern in elderly patients. Treatment(rigid and non-rigid immobilization, anterior screw fixation of the odontoid and posterior C1-C2 fusion) remains controversial and represents a unique challenge for the treating surgeon. The aims of treatment in the elderly is to quickly restore pre-injury function while decreasing morbidity and mortality associated with inactivity, immobilization with rigid collar and prolonged hospitalization. Conservative treatment of type Ⅱ odontoid fractures is associated with relatively high rates of non-union and in a few cases delayed instability. Options for treatment of symptomatic non-unions include surgical fixation or prolonged rigid immobilization. In this report we present the case of a 73-year-old woman with post-traumatic odontoid nonunion successfully treated with Teriparatide systemic anabolic therapy. Complete fusion and resolution of the symptoms was achieved 12 wk after the onset of the treatment. Several animal and clinical studies have confirmed the potential role of Teriparatide in enhancing fracture healing. Our case suggests that Teriparatide may have a role in improving fusion rates of C2 fractures in elderly patients.

Early Treatment Outcome of Humeral Shaft Fracture Non-Union in Adults: Comparative Study of Plating versus Interlocking Nailing

Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is a major problem in this part of the world. This non-union is a major treatment challenge with increased cost of care and morbidity in this part of the world. Humeral shaft non-union can be treated with locked intra-medullary nailing (LIMN) or dynamic compression plating (DCP). Study on comparison of these methods of fixation in this part of the world is scarce in literature search, hence the reason for this study. Objective: The objectives of this study are: (1) to compare early clinical outcome following fixation of humeral shaft fracture nonunion with DCP versus LIMN;(2) to compare the time of radiologic fracture union of DCP with LIMN;(3) to compare complications following fixation of humeral shaft fracture nonunion with DCP versus LIMN. Patients and Methods: This was a randomized control study done for 2 years in which fifty adult patients with humeral shaft non-union were recruited. The patients were grouped into 2 (P = DCP & N = LIMN). Forty five of the patients completed the follow up periods of the study and then analyzed. The P group had ORIF with DCP while the N group had ORIF with LIMN. Both groups had grafting with cancellous bones. Each patient was followed up for a period of 6 months at the time which radiographic union is expected. Any patient without clinical and/or radiographic evidence of union after six months of surgery was diagnosed as having recurrent non-union. The data generated was analyzed using SPSS Version 23. The results were presented in charts and tables. The paired t-test was used while considering p value Result: Forty five patients completed follow up. There was a male preponderance (4:1), right humerus predominated (3:2). Motor vehicular accidents were the commonest cause of the fractures (62%). Most non-union fractures occurred at the level of the middle 3rd of the humeral shaft (60%). Failed TBS treatment was the commonest indication for the osteosynthesis (71%). More patients had plating (53%) compared to 47% who had LIMN. Most patients (93.4%) had union between 3 to 6 months irrespective of fixation type with no significant statistical difference between the union rate of DCP and LIMN (p value 0.06) with similar functional outcome and complication rates irrespective of the type of fixation. Conclusion: This study showed that the success rates in term of fracture union, outcome functional grades and complication rates were not directly dependent on the types of the fixation: plating or locked intra-medullary nailing.

FRACTURE序列在中轴型脊柱关节炎骶髂关节结构性病变中的诊断价值

目的:评估限制回波间隔的快速梯度回波类CT成像(FRACTURE)序列在检测中轴型脊柱关节炎(SpA)骶髂关节结构病变中的诊断价值。方法:回顾性分析83例确诊中轴型SpA患者在2021年12月-2022年8月进行骶髂关节MRI和CT检查的影像资料。评估图像包括FRACTURE、T_(1)WI序列和CT平扫图像。对骶髂关节的影像图像进行结构性病变评分:关节间隙变化(0~5分)、骨质侵蚀(0~3分)和骨质硬化(0~2分)。根据修改后的纽约标准评分系统对骶髂关节炎进行综合评分。结果:总共有166个骶髂关节图像(83名受试者)可供分析。以CT图像作为参考标准,FRACTURE序列在关节间隙改变、骨质侵蚀、骨质硬化和骶髂关节炎综合评分与CT结果表现出较高的一致性,AUC分别为0.908、0.943、0.918和0.944。与T_(1)WI相比,FRACTURE在关节间隙变化(91.8%vs.70.5%)、骨质侵蚀(93.3%vs.56.4%)、骨质硬化(94%vs.77.6%)和骶髂关节炎综合评分(98.9%vs.75.3%)方面具有更高的诊断准确性。结论:FRACTURE成像可以评估中轴型SpA患者骶髂关节的结构性病变,并显示出良好的诊断性能。

Study of hydro-mechanical behaviours of rough rock fracture with shear dilatancy and asperities using shear-flow model

The geometric properties of fracture surfaces significantly influence shear-seepage in rock fractures,introducing complexities to fracture modelling.The present study focuses on the hydro-mechanical behaviours of rough rock fractures during shear-seepage processes to reveal how dilatancy and fracture asperities affect these phenomena.To achieve this,an improved shear-flow model(SFM)is proposed with the incorporation of dilatancy effect and asperities.In particular,shear dilatancy is accounted for in both the elastic and plastic stages,in contrast to some existing models that only consider it in the elastic stage.Depending on the computation approaches for the peak dilatancy angle,three different versions of the SFM are derived based on Mohr-Coulomb,joint roughness coefficient-joint compressive strength(JRC-JCS),and Grasselli’s theories.Notably,this is a new attempt that utilizes Grasselli’s model in shearseepage analysis.An advanced parameter optimization method is introduced to accurately determine model parameters,addressing the issue of local optima inherent in some conventional methods.Then,model performance is evaluated against existing experimental results.The findings demonstrate that the SFM effectively reproduces the shear-seepage characteristics of rock fracture across a wide range of stress levels.Further sensitivity analysis reveals how dilatancy and asperity affect hydraulic properties.The relation between hydro-mechanical properties(dilatancy displacement and hydraulic conductivity)and asperity parameters is analysed.Several profound understandings of the shear-seepage process are obtained by exploring the phenomenon under various conditions.

Numerical modeling of fracture propagation of supercritical CO_(2)compound fracturing

The exploitation of shale gas is promising due to depletion of the conventional energy and intensification of the greenhouse effect.In this paper,we proposed a heat-fluid-solid coupling damage model of supercritical CO_(2)(SC-CO_(2))compound fracturing which is expected to be an efficient and environmentally friendly way to develop shale gas.The coupling model is solved by the finite element method,and the results are in good agreement with the analytical solutions and fracturing experiments.Based on this model,the fracture propagation characteristics at the two stages of compound fracturing are studied and the influence of pressurization rate,in situ stress,bedding angle,and other factors are considered.The results show that at the SC-CO_(2)fracturing stage,a lower pressurization rate is conducive to formation of the branches around main fractures,while a higher pressurization rate inhibits formation of the branches around main fractures and promotes formation of the main fractures.Both bedding and in situ stress play a dominant role in the fracture propagation.When the in situ stress ratio(δ_(x)/δ_(y))is 1,the presence of bedding can reduce the initiation pressure and failure pressure.Nevertheless,it will cause the fracture to propagate along the bedding direction,reducing the fracture complexity.In rocks without bedding,hydraulic fracturing has the lengthening and widening effects for SC-CO_(2)induced fracture.In shale,fractures induced at the hydraulic fracturing stage are more likely to be dominated by in situ stresses and have a shorter reorientation radius.Therefore,fracture branches propagating along the maximum principal stress direction may be generated around the main fractures induced by SC-CO_(2)at the hydraulic fracturing stage.When the branches converge with the main fractures,fracture zones are easily formed,and thus the fracture complexity and damage area can be significantly increased.The results are instructive for the design and application of SC-CO_(2)compound fracturing.

Shared genetic architecture highlights the bidirectional association between major depressive disorder and fracture risk

Background There is limited evidence suggesting that osteoporosis might exacerbate depressive symptoms,while more studies demonstrate that depression negatively affects bone density and increases fracture risk.Aims To explore the relationship between major depressive disorder(MDD)and fracture risk.Methods We conducted a nested case-control analysis(32670 patients with fracture and 397017 individuals without fracture)and a matched cohort analysis(16496 patients with MDD and 435492 individuals without MDD)in the same prospective UK Biobank data set.Further,we investigated the shared genetic architecture between MDD and fracture with linkage disequilibrium score regression and the MiXeR statistical tools.We used the conditional/conjunctional false discovery rate approach to identify the specific shared loci.We calculated the weighted genetic risk score for individuals in the UK Biobank and logistic regression was used to confirm the association observed in the prospective study.Results We found that MDD was associated with a 14%increase in fracture risk(hazard ratio(HR)1.14,95%CI 1.14 to 1.15,p<0.001)in the nested case-control analysis,while fracture was associated with a 72%increase in MDD risk(HR 1.72,95%CI 1.64 to 1.79,p<0.001)in the matched cohort analysis,suggesting a longitudinal and bidirectional relationship.Further,genetic summary data suggested a genetic overlap between MDD and fracture.Specifically,we identified four shared genomic loci,with the top signal(rs7554101)near SGIP1.The protein encoded by SGIP1 is involved in cannabinoid receptor type 1 signalling.We found that genetically predicted MDD was associated with a higher risk of fracture and vice versa.In addition,we found that the higher expression level of SGIP1 in the spinal cord and muscle was associated with an increased risk of fracture and MDD.Conclusions The genetic pleiotropy between MDD and fracture highlights the bidirectional association observed in the epidemiological analysis.The shared genetic components(such as SGIP1)between the diseases suggest that modulating the endocannabinoid system could be a potential therapeutic strategy for both MDD and bone loss.

Management and classification of the fracture of lateral process of talus:An overview and literature update

Fracture of the lateral process of the talus(FLPT)is uncommon in clinical practice and can be easily missed or misdiagnosed.In recent years,as researchers from all over the world have further deepened their research on FLPT,there has been a breakthrough in the classification,and the methods and principles of clinical management have changed accordingly;however,there is still no standardized guideline for the diagnosis and management of FLPT,and there have been few relevant literature review articles related to this kind of fracture in the past at least 5 years.In this article,we review the clinical classification,classification-based therapeutic recommendations,and prognosis of FLPT,with the aim of providing a reference for the clinical diagnosis and management of this infrequent fracture.

Effect of fracture fluid flowback on shale microfractures using CT scanning

The field data of shale fracturing demonstrate that the flowback performance of fracturing fluid is different from that of conventional reservoirs,where the flowback rate of shale fracturing fluid is lower than that of conventional reservoirs.At the early stage of flowback,there is no single-phase flow of the liquid phase in shale,but rather a gas-water two-phase flow,such that the single-phase flow model for tight oil and gas reservoirs is not applicable.In this study,pores and microfractures are extracted based on the experimental results of computed tomography(CT)scanning,and a spatial model of microfractures is established.Then,the influence of rough microfracture surfaces on the flow is corrected using the modified cubic law,which was modified by introducing the average deviation of the microfracture height as a roughness factor to consider the influence of microfracture surface roughness.The flow in the fracture network is simulated using the modified cubic law and the lattice Boltzmann method(LBM).The results obtained demonstrate that most of the fracturing fluid is retained in the shale microfractures,which explains the low fracturing fluid flowback rate in shale hydraulic fracturing.

Creep constitutive model considering nonlinear creep degradation of fractured rock

Stability analysis of underground constructions requires a model study of rock masses’ long-term performance. Creep tests under different stress conditions was conducted on intact granite and granite samples fractured at 30° and 45° angles. The experimental results indicate that the steady creep strain rates of intact and fractured rock present an exponential increase trend with the increase of stress level. A nonlinear creep model is developed based on the experimental results, in which the initial damage caused by fracture together with the damage caused by constant load have been taken into consideration. The fitting analysis results indicated that the model proposed is more accurate at identifying the full creep regions in fractured granite, especially the accelerated stage of creep deformation. The least-square fit error of the proposed creep model is significantly lower than that of Nishihara model by almost an order of magnitude. An analysis of the effects of elastic modulus, viscosity coefficient, and damage factors on fractured rock strain rate and creep strain is conducted. If no consideration is given to the effects of the damage, the proposed nonlinear creep model can degenerate into to the classical Nishihara model.

Complication rates after direct anterior vs posterior approach for hip hemiarthroplasty in elderly individuals with femoral neck fractures

BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with no consensus regarding the superiority of any single approach.AIM To compare early postoperative complications after implementing the direct anterior and posterior approaches(PL)for hip hemiarthroplasty after femoral neck fractures.METHODS This is a comparative,retrospective,single-center cohort study conducted at a university hospital.Between March 2008 and December 2018,273 patients(a total of 280 hips)underwent bipolar hemiarthroplasties(n=280)for displaced femoral neck fractures using either the PL(n=171)or the minimally invasive direct anterior approach(DAA)(n=109).The choice of approach was related to the surgeons’practices;the implant types were similar and unrelated to the approach.Dislocation rates and other complications were reviewed after a minimum followup of 6 mo.RESULTS Both treatment groups had similarly aged patients(mean age:82 years),sex ratios,patient body mass indexes,and patient comorbidities.Surgical data(surgery delay time,operative time,and blood loss volume)did not differ significantly between the groups.The 30 d mortality rate was higher in the PL group(9.9%)than in the DAA group(3.7%),but the difference was not statistically significant(P=0.052).Among the one-month survivors,a significantly higher rate of dislocation was observed in the PL group(14/154;9.1%)than in the DAA group(0/105;0%)(P=0.002).Of the 14 patients with dislocation,8 underwent revision surgery for recurrent instability(posterior group),and one of them had 2 additional procedures due to a deep infection.The rate of other complications(e.g.,perioperative and early postoperative periprosthetic fractures and infection-related complications)did not differ significantly between the groups.CONCLUSION These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate(<1%)than the PL.

Evaluating the stability and volumetric flowback rate of proppant packs in hydraulic fractures using the lattice Boltzmann-discrete element coupling method

The stability and mobility of proppant packs in hydraulic fractures during hydrocarbon production are numerically investigated by the lattice Boltzmann-discrete element coupling method(LB-DEM).This study starts with a preliminary proppant settling test,from which a solid volume fraction of 0.575 is calibrated for the proppant pack in the fracture.In the established workflow to investigate proppant flowback,a displacement is applied to the fracture surfaces to compact the generated proppant pack as well as further mimicking proppant embedment under closure stress.When a pressure gradient is applied to drive the fluid-particle flow,a critical aperture-to-diameter ratio of 4 is observed,above which the proppant pack would collapse.The results also show that the volumetric proppant flowback rate increases quadratically with the fracture aperture,while a linear variation between the particle flux and the pressure gradient is exhibited for a fixed fracture aperture.The research outcome contributes towards an improved understanding of proppant flowback in hydraulic fractures,which also supports an optimised proppant size selection for hydraulic fracturing operations.

A method to interpret fracture aperture of rock slope using adaptive shape and unmanned aerial vehicle multi-angle nap-of-the-object photogrammetry

The aperture of natural rock fractures significantly affects the deformation and strength properties of rock masses,as well as the hydrodynamic properties of fractured rock masses.The conventional measurement methods are inadequate for collecting data on high-steep rock slopes in complex mountainous regions.This study establishes a high-resolution three-dimensional model of a rock slope using unmanned aerial vehicle(UAV)multi-angle nap-of-the-object photogrammetry to obtain edge feature points of fractures.Fracture opening morphology is characterized using coordinate projection and transformation.Fracture central axis is determined using vertical measuring lines,allowing for the interpretation of aperture of adaptive fracture shape.The feasibility and reliability of the new method are verified at a construction site of a railway in southeast Tibet,China.The study shows that the fracture aperture has a significant interval effect and size effect.The optimal sampling length for fractures is approximately 0.5e1 m,and the optimal aperture interpretation results can be achieved when the measuring line spacing is 1%of the sampling length.Tensile fractures in the study area generally have larger apertures than shear fractures,and their tendency to increase with slope height is also greater than that of shear fractures.The aperture of tensile fractures is generally positively correlated with their trace length,while the correlation between the aperture of shear fractures and their trace length appears to be weak.Fractures of different orientations exhibit certain differences in their distribution of aperture,but generally follow the forms of normal,log-normal,and gamma distributions.This study provides essential data support for rock and slope stability evaluation,which is of significant practical importance.

Experimental investigation on coal pore-fracture variation and fractal characteristics synergistically affected by solvents for improving clean gas extraction

Chemical solvents instead of pure water being as hydraulic fracturing fluid could effectively increase permeability and improve clean methane extraction efficiency.However,pore-fracture variation features of lean coal synergistically affected by solvents have not been fully understood.Ultrasonic testing,nuclear magnetic resonance analysis,liquid phase mass spectrometry was adopted to comprehensively analyze pore-fracture change characteristics of lean coal treated by combined solvent(NMP and CS_(2)).Meanwhile,quantitative characterization of above changing properties was conducted using geometric fractal theory.Relationship model between permeability,fractal dimension and porosity were established.Results indicate that the end face fractures of coal are well developed after CS2and combined solvent treatments,of which,end face box-counting fractal dimensions range from 1.1227 to 1.4767.Maximum decreases in ultrasonic longitudinal wave velocity of coal affected by NMP,CS_(2)and combined solvent are 2.700%,20.521%,22.454%,respectively.Solvent treatments could lead to increasing amount of both mesopores and macropores.Decrease ratio of fractal dimension Dsis 0.259%–2.159%,while permeability increases ratio of NMR ranges from 0.1904 to 6.4486.Meanwhile,combined solvent could dissolve coal polar and non-polar small molecules and expand flow space.Results could provide reference for solvent selection and parameter optimization of permeability-enhancement technology.

Estimation of the anisotropy of hydraulic conductivity through 3D fracture networks using the directional geological entropy

With an extension of the geological entropy concept in porous media,the approach called directional entrogram is applied to link hydraulic behavior to the anisotropy of the 3D fracture networks.A metric called directional entropic scale is used to measure the anisotropy of spatial order in different directions.Compared with the traditional connectivity indexes based on the statistics of fracture geometry,the directional entropic scale is capable to quantify the anisotropy of connectivity and hydraulic conductivity in heterogeneous 3D fracture networks.According to the numerical analysis of directional entrogram and fluid flow in a number of the 3D fracture networks,the hydraulic conductivities and entropic scales in different directions both increase with spatial order(i.e.,trace length decreasing and spacing increasing)and are independent of the dip angle.As a result,the nonlinear correlation between the hydraulic conductivities and entropic scales from different directions can be unified as quadratic polynomial function,which can shed light on the anisotropic effect of spatial order and global entropy on the heterogeneous hydraulic behaviors.

A coupled thermo-mechanical peridynamic model for fracture behavior of granite subjected to heating and water-cooling processes

Thermal damage and thermal fracture of rocks are two important indicators in geothermal mining projects.This paper investigates the effects of heating and water-cooling on granite specimens at various temperatures.The laboratory uniaxial compression experiments were also conducted.Then,a coupled thermo-mechanical ordinary state-based peridynamic(OSB-PD)model and corresponding numerical scheme were developed to simulate the damage of rocks after the heating and cooling processes,and the change of crack evolution process was predicted.The results demonstrate that elevated heating temperatures exacerbate the thermal damage to the specimens,resulting in a decrease in peak strength and an increase in ductility of granite.The escalating occurrence of thermal-induced cracks significantly affects the crack evolution process during the loading phase.The numerical results accurately reproduce the damage and fracture characteristics of the granite under different final heating temperatures(FHTs),which are consistent with the test results in terms of strength,crack evolution process,and failure mode.

Effects of thawing-induced softening on fracture behaviors of frozen rock

Due to the presence of ice and unfrozen water in pores of frozen rock,the rock fracture behaviors are susceptible to temperature.In this study,the potential thawing-induced softening effects on the fracture behaviors of frozen rock is evaluated by testing the tension fracture toughness(KIC)of frozen rock at different temperatures(i.e.-20℃,-15℃,-12℃,-10℃,-8℃,-6℃,-4℃,-2℃,and 0℃).Acoustic emission(AE)and digital image correlation(DIC)methods are utilized to analyze the microcrack propagation during fracturing.The melting of pore ice is measured using nuclear magnetic resonance(NMR)method.The results indicate that:(1)The KIC of frozen rock decreases moderately between-20℃ and-4℃,and rapidly between-4℃ and 0℃.(2)At-20℃ to-4℃,the fracturing process,deduced from the DIC results at the notch tip,exhibits three stages:elastic deformation,microcrack propagation and microcrack coalescence.However,at-4℃e0℃,only the latter two stages are observed.(3)At-4℃e0℃,the AE activities during fracturing are less than that at-20℃ to-4℃,while more small events are reported.(4)The NMR results demonstrate a reverse variation trend in pore ice content with increasing temperature,that is,a moderate decrease is followed by a sharp decrease and-4℃ is exactly the critical temperature.Next,we interpret the thawing-induced softening effect by linking the evolution in microscopic structure of frozen rock with its macroscopic fracture behaviors as follow:from-20℃ to-4℃,the thickening of the unfrozen water film diminishes the cementation strength between ice and rock skeleton,leading to the decrease in fracture parameters.From-4℃ to 0℃,the cementation effect of ice almost vanishes,and the filling effect of pore ice is reduced significantly,which facilitates microcrack propagation and thus the easier fracture of frozen rocks.

Numerical manifold method for thermo-mechanical coupling simulation of fractured rock mass

As a calculation method based on the Galerkin variation,the numerical manifold method(NMM)adopts a double covering system,which can easily deal with discontinuous deformation problems and has a high calculation accuracy.Aiming at the thermo-mechanical(TM)coupling problem of fractured rock masses,this study uses the NMM to simulate the processes of crack initiation and propagation in a rock mass under the influence of temperature field,deduces related system equations,and proposes a penalty function method to deal with boundary conditions.Numerical examples are employed to confirm the effectiveness and high accuracy of this method.By the thermal stress analysis of a thick-walled cylinder(TWC),the simulation of cracking in the TWC under heating and cooling conditions,and the simulation of thermal cracking of the SwedishÄspöPillar Stability Experiment(APSE)rock column,the thermal stress,and TM coupling are obtained.The numerical simulation results are in good agreement with the test data and other numerical results,thus verifying the effectiveness of the NMM in dealing with thermal stress and crack propagation problems of fractured rock masses.

Subclavian vessels injury:An underestimated complication of clavicular fractures

Clavicle fractures are frequent orthopedic injuries,often resulting from direct trauma or a fall.Most clavicle fractures are treated conservatively without any complications or adverse effects.Concomitant injuries of the subclavian vein or artery are rarely encountered and most commonly associated with high-energy trauma or comminuted clavicle fractures.They are potentially life-threatening conditions leading to hemorrhage,hematoma,pseudoaneurysm or upper limb ischemia.However,the clinical presentation might be obscure and easily missed,particularly in closed and minimally displaced clavicular fractures,and timely diagnosis relies on early clinical suspicion.Currently,computed tomography angiography has largely replaced conventional angiography for the assessment of subclavian vessel patency,as it demonstrates high accuracy and temporal resolution,acute turnaround time,and capability of multiplanar reconstruction.Depending on the hemodynamic stability of the patient and the severity of the injury,subclavian vessel lesions can be treated conservatively with observation and serial evaluation or operatively.Interventional vascular techniques should be considered in patients with serious hemorrhage and limb ischemia,followed by stabilization of the displaced clavicle fracture.This review aims to provide a comprehensive overview of the incidence,clinical presentation,diagnostic approaches,and current management strategies of clavicle fractures associated with subclavian vessel injuries.

Imaging characteristics and treatment strategies for carotid artery occlusion caused by skull base fracture:Three case reports

BACKGROUND Traumatic internal carotid artery(ICA)occlusion is a rare complication of skull base fractures,characterized by high mortality and disability rates,and poor prognosis.Therefore,timely discovery and correct management are crucial for saving the lives of such patients and improving their prognosis.This article retrospectively analyzed the imaging and clinical data of three patients,to explore the imaging characteristics and treatment strategies for carotid artery occlusion,combined with severe skull base fractures.CASE SUMMARY This case included three patients,all male,aged 21,63,and 16 years.They underwent plain film skull computed tomography(CT)examination at the onset of their illnesses,which revealed fractures at the bases of their skulls.Ultimately,these cases were definitively diagnosed through CT angiography(CTA)examinations.The first patient did not receive surgical treatment,only anticoagulation therapy,and recovered smoothly with no residual limb dysfunction(Case 1).The other two patients both developed intracranial hypertension and underwent decompressive craniectomy.One of these patients had high intracranial pressure and significant brain swelling postoperatively,leading the family to choose to take him home(Case 2).The other patient also underwent decompressive craniectomy and recovered well postoperatively with only mild limb motor dysfunction(Case 3).We retrieved literature from PubMed on skull base fractures causing ICA occlusion to determine the imaging characteristics and treatment strategies for this type of disease.CONCLUSION For patients with cranial trauma combined with skull base fractures,it is essential to complete a CTA examination as soon as possible,to screen for blunt cerebrovascular injury.

Discontinuity development patterns and the challenges for 3D discrete fracture network modeling on complicated exposed rock surfaces

Natural slopes usually display complicated exposed rock surfaces that are characterized by complex and substantial terrain undulation and ubiquitous undesirable phenomena such as vegetation cover and rockfalls.This study presents a systematic outcrop research of fracture pattern variations in a complicated rock slope,and the qualitative and quantitative study of the complex phenomena impact on threedimensional(3D)discrete fracture network(DFN)modeling.As the studies of the outcrop fracture pattern have been so far focused on local variations,thus,we put forward a statistical analysis of global variations.The entire outcrop is partitioned into several subzones,and the subzone-scale variability of fracture geometric properties is analyzed(including the orientation,the density,and the trace length).The results reveal significant variations in fracture characteristics(such as the concentrative degree,the average orientation,the density,and the trace length)among different subzones.Moreover,the density of fracture sets,which is approximately parallel to the slope surface,exhibits a notably higher value compared to other fracture sets across all subzones.To improve the accuracy of the DFN modeling,the effects of three common phenomena resulting from vegetation and rockfalls are qualitatively analyzed and the corresponding quantitative data processing solutions are proposed.Subsequently,the 3D fracture geometric parameters are determined for different areas of the high-steep rock slope in terms of the subzone dimensions.The results show significant variations in the same set of 3D fracture parameters across different regions with density differing by up to tenfold and mean trace length exhibiting differences of 3e4 times.The study results present precise geological structural information,improve modeling accuracy,and provide practical solutions for addressing complex outcrop issues.