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BACKGROUND: Guidelines recommend dual-energy x-ray absorptiometry (DXA) screening to assess fracture risk and benefit from antiresorptive therapy in men with metastatic hormone-sensitive prostate cancer (mHSPC) on androgen deprivation therapy (ADT). However,

To ensure the safety of geological disposal of high-level radioactive waste, in-situ experiments have been carried out to examine the behavior of rocks in underground research laboratories (URLs). At the Meuse/Haute-Marne URL in France, the French National Radioactive Waste Management Agency (Andra) has been assessing the Callovo-Oxfordian claystone (COx) as potential host rock of geological disposal by subjecting the COx to in-situ heating mimicking exothermic radioactive waste. Results of the in-situ experiments are used to validate and bolster the numerical simulators for predicting the thermo-hydromechanically (THM) coupled behavior of the COx. The numerical simulators are, however, yet to be tested for predicting the failure and fracture development of the COx during heating, which is of paramount importance to the safety of the geological disposal. In this research, we modelled a recently carried out in-situ experiment at the Meuse/Haute-Marne URL using the TOUGH-FLAC simulator to predict the failure and fracture development of the COx during heating. The objectives are to examine the effects of (i) the weak bedding planes, (ii) the softening rate of matrix/weak plane strengths, and (iii) the stiffness anisotropy of the COx on the development of shear and tensile fractures during heating. Results show that considering failure along the weak planes enabled accurate predictions of fracture development. Also, fracture development intensified at a softening rate beyond a threshold level and the geometry of fractures was significantly affected by the stiffness anisotropy. These results will help boost the reliability of the safety and performance assessment of geological disposal in claystone.

ObjectiveTo evaluate differences based on intrauterine device (IUD) frame geometry in force, and stress, and strain at the stem/arms junction during simulated IUD removal.Study designWe manufactured injection-molded frame models for three Nova-T IUDs (Mirena [model M]; Liletta [model L]; Kyleena [model K]) and a Tatum-T IUD (Paragard [model P]) at two-times scaling. We created a custom fixture to simulate the uterus and used a screw-driven machine to pull models at various displacement rates through the 10 cm fixture cavity to measure force and strain and calculate stress at the IUD stem/arms junction. We tested models at 30 mm/min and higher displacement rates for exploratory analyses. We used Mann-Whitney U test for statistical testing.ResultsWe completed testing at 30 mm/min using five of each Nova-T model and nine model P samples. Resistance against the cavity walls created significantly more force on model P (11.83, interquartile range [IQR] 11.61-12.31) than any Nova-T model samples (p

Orthopaedic trauma remains a leading cause of patient morbidity, mortality, and global health care burden. Although significant advances have been made in the diagnosis, treatment, and rehabilitation of these injuries, complications such as malunion, nonunion, infection, disuse muscle atrophy and osteopenia, and incomplete return to baseline function still occur. The significant inherent clinical variability in fracture care such as differing patient demographics, injury patterns, and treatment protocols make standardized and replicable study, especially of cellular and molecular based mechanisms, nearly impossible. Hence, the scientists dedicated to improving therapy and treatments for patients with orthopaedic trauma rely on preclinical models. Preclinical models have proven to be invaluable in understanding the timing between implant insertion and bacterial inoculation on the bioburden of infection. Posttraumatic arthritis (PTOA) can take years to develop clinically, but with a porcine pilon fracture model, posttraumatic arthritis can be reliably induced, so different surgical and therapeutic strategies can be tested in prevention. Conversely, the racehorse presents a well-accepted model of naturally occurring PTOA. With preclinical polytrauma models focusing on chest injury, abdominal injury, multiple fractures, and/or head injury, one can study how various injury patterns affect fracture healing can be systemically studied. Finally, these preclinical models serve as a translational bridge to for clinical application in human patients. With selection of the right preclinical model, studies can build a platform to decrease the risk of emerging technologies and provide foundational support for therapeutic clinical trials. In summary, orthopaedic trauma preclinical models allow scientists to simplify a complex clinical challenge, to understand the basic pathways starting with lower vertebrate models. Then, R&D efforts progress to higher vertebrate models to build in more complexity for translation of findings to the clinical practice.

This work investigates the hydrogen embrittlement (HE) behavior of Nickel-201 alloy using experimental and numerical approaches. In experimentation, the effect of electrochemical hydrogen charging on the deformation behavior of tensile oligocrystals is investigated at different strain rates. Irrespective of the strain rate levels, all the hydrogen-charged tensile oligocrystals exhibited intergranular (IG) fracture exclusively along the random high-angle grain boundaries (RHAGBs). At the same time, no crack was observed along the coincident site lattice (CSL) Σ 3 type grain boundaries. The absence of an interconnected grain boundary network, lower stress levels, and insensitivity of H-induced IG fracture to the strain rate levels of investigated FCC oligocrystals (with low lattice hydrogen diffusion coefficient) established the insignificance of dynamic H-redistribution toward HE. In numerical simulations, a crystal plasticity-phase field fracture finite element model simulates the macroscopic tensile response and corresponding microscopic fracture evolution behavior for hydrogen-free and hydrogen-charged tensile oligocrystals. The experimental results corroborated by numerical simulations, validate that the reduction in fracture energy of RHAGBs, induced by hydrogen segregation through thermodynamic equilibrium during hydrogen charging prior to deformation, is the dominating factor governing HE. • Hydrogen embrittlement (HE) of Ni- oligocrystals at various strain rate is investigated. • Experimental results are corroborated by crystal plasticity-phase field fracture simulations. • H-induced intergranular fracture initiated and propagated along the RHAGBs only. • H-segregation by thermodynamic equilibrium established prior to deformation governs the HE. [ABSTRACT FROM AUTHOR]

The success of foam-induced flow diversion in fractured carbonates hinges on proper injection strategies, requiring an in-depth understanding of the factors responsible for stimulating fracture–matrix interactions. In this study, we present a novel investigation of the interactions between the fracture and the matrix influenced by the mobility control effect during CH4-foam injections. These interactions were probed at the pore scale using a three-phase flow system integrated with a high-resolution micro-CT scanner. In situ phase saturations were monitored and quantified to interpret the resulting fluid transport at various injection parameters. At the initial stage of foam injection, the surfactant solution was able to invade the matrix leading to water/oil displacement events, however, impeding gas penetration. Increasing total injection velocity produced higher in situ foam quality in the fracture than the injected quality, where significant fraction of the surfactant solution from the foam was primarily diverted into the matrix. A pronounced increase in the average gas saturation within the matrix was only observed at the highest injection velocity. The pore-scale evidence showed the occurrence of combined displacement processes (water/oil, gas/oil, gas/oil/water) in the matrix, attributed to the established mobility control in the fracture, which contributed to the diversion of surfactant solution and gas to the matrix. Lastly, the injection–soaking–production technique effectively mobilized the residual oil after a long injection process of CH4-foam. At this stage, the surfactant solution was no longer playing a role as the primary invading fluid; rather, it was the diverted gas that led to the increase in the matrix-oil production. [ABSTRACT FROM AUTHOR]

Background: Recent literature has found a consensus in favor of conservative treatment for type II supracondylar humeral fractures (SCHF). This retrospective observational study compares the short- to medium-term functional outcomes of conservative versus surgical treatment in 31 patients with SCHF (Gartland II and III) to assess the potential superiority of one approach over the other. Materials and methods: Thirty-one pediatric patients treated for SCHF—19 classified as Gartland II and 12 as Gartland III—were assessed in our department. Eight patients underwent closed reduction and cast immobilization, 22 were treated with closed reduction and percutaneous pinning, and one underwent open reduction and internal fixation with plates. Clinical and functional data were collected during follow-up, including elbow and forearm range of motion (ROM), grip strength, carrying angle, Flynn's criteria, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results: The average follow-up was 3.3 years (± 1.4 years). All patients demonstrated good functional recovery. According to Flynn's criteria, 85% and 81% of the patients achieved a satisfactory outcome in elbow flexion and carrying angle, respectively. No cases of nerve injuries were reported. Four patients developed cubitus varus in the Gartland II group, which was treated with closed reduction and casting with the initial alignment maintained (without a loss of reduction during the first week). However, compared to this group that was conservatively treated, functional and clinical outcomes were significantly better in the group with SCHF Gartland II treated with reduction and pinning (p < 0.05). Conclusions: Although some recent studies have demonstrated positive outcomes with conservative treatment for both Gartland IIA and IIB fractures, the short- to medium-term functional results in our study emphasize that superior outcomes were obtained with surgical treatment for Gartland II fractures when compared to those treated conservatively. Trial registration: This study was performed in line with the principles of the Declaration of Helsinki. Ethics approval was obtained from our institute's ethics committee (registry no. 3511). Level of evidence: Therapeutic level III [ABSTRACT FROM AUTHOR]

Summary This case report describes a novel fixation technique of scapular neck fracture in a 2‐week‐old Arabian foal using two 3.5 mm tibial‐plateau‐levelling‐osteotomy (TPLO) locking plates originally designed for small animal orthopaedic surgery. The foal presented with a traumatic short oblique scapular neck fracture. Fracture fixation was performed under general anaesthesia using two anatomically pre‐shaped 3.5 mm TPLO locking plates; one on each side of the spine of the scapula. Fracture fixation was successful using two TPLO locking plates. Minimal soft tissue manipulation and identification of the suprascapular nerve allowed for relatively atraumatic application of the implants. The implants were left in place. Follow‐up evaluation 2 years after surgical intervention confirmed the horse to be sound with no clinical or gait abnormalities. Stabilisation of a short oblique scapular neck fracture in a 2‐week‐old foal with an anatomically pre‐shaped implant led to a good outcome in this case report. No complications were encountered during the recovery period. The use of an anatomically pre‐shaped locking plate intended for use on dogs, which is widely available in the veterinary industry, has proven to be a viable alternative for a scapular neck fracture fixation in this foal. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Acromial stress fracture (ASF) is an uncommon but acknowledged complication of reverse total shoulder arthroplasty (RTSA). There is no standardised method to directly measure the bone mineral density of the acromion to allow a detailed analysis of the potential mechanism of ASF. The aim is to establish a reliable and reproducible technique for measurement of acromial density on computer tomography (CT).A retrospective review on CT scans obtained for three groups of patients: those planned for RTSA (n = 26); age and gender‐matched non‐operative (n = 26); and young non‐operative patients (n = 28) were performed. Standardised axial images of 1 mm thickness at 1 mm increments were created following horizontal straightening on the coronal and sagittal views. To assess inter‐rater reliability, two senior CT radiographers performed density measurements using standard region of interest (ROI) tool on the CTs with the ROI placed on the mid (ROI 1) and posterior (ROI 2) acromion. ROIs were selected as the most common locations for acromion fracture post RTSA. Measurements were repeated at least 6 weeks apart. Intra‐class coefficients (ICC) were used to determine intra‐ and inter‐rater reliability.ICCs demonstrated good to high intra‐rater and inter‐rater reliability for both ROI 1 and ROI 2 across all three groups. The lower margin of 95% confidence intervals was more than 0 for all intra‐class coefficients.This study demonstrates a reliable method of measuring acromion density on CT. This method can be used to assess bone mineral density in the clinical setting and in future studies investigating ASF following RTSA. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions Hip fracture (HF) has been described as the “last fracture of life” in the elderly, so the assessment of HF risk is extremely important. Currently, few studies have examined the relationship between imaging data from chest computed tomography (CT) and HF. This study demonstrated that pectoral muscle index (PMI) and vertebral body attenuation values could predict HF, aiming to opportunistically assess the risk of HF in patients without bone mineral density (BMD) based on chest CT for other diseases.In the retrospective study, 800 participants who had both BMD and chest CT were enrolled from January 2021 to January 2024. After exclusion, 472 patients were finally enrolled, divided into the healthy control (HC) group and the HF group. Clinical data were collected, and differences between the two groups were compared. A predictive model was constructed based on the PMI and CT value of the fourth thoracic vertebra (T4HU) by logistic regression analysis, and the predictive effect of the model was analyzed by using the receiver operating characteristic (ROC) curve. Finally, the clinical utility of the model was analyzed using decision curve analysis (DCA) and clinical impact curves.Both PMI and T4HU were lower in the HF group than in the HC group (p < 0.05); low PMI and low T4HU were risk factors for HF. The predictive model incorporating PMI and T4HU on the basis of age and BMI had excellent diagnostic efficacy with an area under the curve (AUC) of 0.865 (95% confidence interval [CI]: 0.830–0.894, p < 0.01), sensitivity and specificity of 0.820 and 0.754, respectively. The clinical utility of the model was validated using calibration curves and DCA. The AUC of the predictive model incorporating BMD based on age and BMI was 0.865 (95% CI: 0.831–0.895, p < 0.01), with sensitivity and specificity of 0.698 and 0.711, respectively. There was no significant difference in diagnostic efficacy between the two models (p = 0.967).PMI and T4HU are predictors of HF in patients. In the absence of dual‐energy x‐ray absorptiometry (DXA), the risk of HF can be assessed by measuring the PMI and T4HU on chest CT examination due to other diseases, and further treatment can be provided in time to reduce the incidence of HF. [ABSTRACT FROM AUTHOR]

Modular metaphyseal engaging (MME) femoral components in total hip arthroplasty (THA) allow optimized femoral length, offset, and anteversion and are useful in patients with unusual proximal femoral anatomy. Fretting, corrosion, and stem fractures above the modular sleeve are complications associated with these implants. The purpose of this study was to identify failure mechanisms of retrieved MME femoral components at our institution, identify all broken stem cases, and evaluate how often an extended trochanteric osteotomy (ETO) was required for removal. All consecutively retrieved MME femoral components from September 2002 to May 2023 were reviewed. Patient demographics, procedure information, component specifications, indications for removal, and requirements for further revision surgery were reviewed. Descriptive statistics were calculated for variables of interest. There were 131 retrieved MME components. The mean age at surgery was 59 years (range, 28 to 75), 49% were women, mean body mass index was 29.4 (range, 20.7 to 33.3), and mean American Society of Anesthesiologists score was 2.4 ± 0.5. There were 102 (78%) stems of 1 design (stem A), and 29 (22%) stems of a different design (stem B). Of 131 components, 10 (7.6%) failed secondary to stem fracture proximal to the modular sleeve. Four of 102 (4%) of stem A and 6 of 29 (21% of stem B) fractured. All broken stems required additional intervention for removal during revision THA, using an ETO (N = 9) or cortical window (N = 1) in which an intraoperative proximal femoral fracture occurred. Broken MME stems present a challenge for orthopaedic surgeons during revision THA. When a stem fracture occurs above the ingrown sleeve, the distal splines may have osseous interdigitation into the clothespin. Thus, when revising a broken MME stem, an ETO should be performed, and the segment should be long enough to allow distal access. [ABSTRACT FROM AUTHOR]

Uncemented femoral stems in hip arthroplasty have shown excellent long-term results, and several systematic studies indicate satisfactory performance of short stems. However, biomechanical and finite element analysis studies have suggested that shorter stems allow greater micromotion, producing greater strain at the implant-bone interface, which potentially increases the risk for periprosthetic fracture (PPF). We sought to assess this risk within our unit. Our institution's arthroplasty database was searched for all primary total hip arthroplasties using short femoral stems performed between July 14, 2009 and August 29, 2022. The overall PPF rate and the PPF rate for individual femoral stems were established. Preoperative X-rays for each case were analyzed to characterize individual proximal femoral geometry. A data analysis was performed to identify risk factors for PPF. For the time period assessed, 3,192 short femoral stems were implanted. This included 1,561 of stem A and 1,631 of stem B. Women constituted 55.37% of the cohort. The average patient age was 66 years (range, 22 to 95). The PPF rate was 0.6%, with 19 PPFs identified at a follow-up of 3 months. There was a significantly higher fracture rate in stem A (0.96%) compared to stem B (0.25%) (P ≤.01). Proximal femoral geometry, age, and sex were not determined to be risk factors for PPF in our cohort. Individual surgeons and surgical approaches appeared to confer no increased risk. There was no significant difference in average stem length, but multivariate analysis identified stem type and stem length as an independent risk factor for PPF. Our study identified individual stem and stem length as independent risk factors for PPF within our cohort. PPF is a multifactorial issue, and consensus on emerging risk factors such as implant design will hopefully inform decisions that can provide further risk reduction for individual patients. [ABSTRACT FROM AUTHOR]

This article addresses butt joining of 1.2 mm thick Ni-Cr superalloy 80 A sheets using a 3.5 kW CO2 laser beam welding (LBW) process, which is critical for gas turbine components, nuclear tube supports and automotive valves in high temperature applications. LBW, chosen for its low heat input and minimal heat-affected zones, was optimized using Taguchi-based gray relationship analysis. The L9 orthogonal array experiment identified the optimal parameter sets for welding speed, laser power, focal length, and shielding gas flow rate that affect tensile strength, microhardness, penetration depth and weld bead. The results were validated using ANOVA analysis, fractography, hardness testing, micrographs and tensile tests. Microstructural variations in fusion and heat affected zones. The optimized parameters resulted in a tensile strength of 817 MPa and a microhardness of 292 HV, demonstrating improved weld quality. [ABSTRACT FROM AUTHOR]

Thoracic vertebral fractures within homes are pivotal public health concerns due to their associated morbidity and significant healthcare expenditures. This study aims to dissect the intricate epidemiology of these injuries, integrating comprehensive risk factors beyond conventional demographics and location analyses. Utilizing a decade of data (2013–2022) from the National Electronic Injury Surveillance System, this study examines thoracic vertebral fractures across age and gender in household settings. Inclusion criteria targeted specific thoracic spine-related terms, analyzing fractures by location (e.g., kitchen, stairs) and associated products. Data processing employed R programming, with statistical analysis focusing on descriptive statistics and multivariate logistic regression, to identify fracture patterns and assess gender differences in fracture risks through Adjusted Odds Ratios (AORs). Analysis of 46,371 thoracic vertebral fractures identified stairs as the primary site (26.81%), with subsequent frequent locations being bedrooms (18.52%), living rooms (17.88%), and kitchens (16.29%). Gender-specific risk analysis revealed females had a higher likelihood of fractures on stairs (AOR = 1.24, 95% CI: 1.16–1.37, P < 0.001) and in bedrooms (AOR = 1.13, 95% CI: 1.09–1.54, P < 0.001). The most affected age group was 51–60, showcasing the multifaceted nature of risk factors beyond mere location. This study transcends prior insights by detailing the influence of various factors, including socioeconomic status and lifestyle, on fracture risk. It emphasizes the complexity of household fractures, highlighting gender and age as pivotal but not exclusive risk determinants. By offering a comprehensive analysis that incorporates a wide array of risk factors, this study advances the understanding of thoracic vertebral fractures in residential environments. It underscores the necessity for targeted preventive measures that are cognizant of the multifactorial nature of these injuries, paving the way for improved safety interventions and public health policies. [ABSTRACT FROM AUTHOR]

This work outlines an efficient deep learning approach for analyzing vascular wall fractures using experimental data with openly accessible source codes (https://doi.org/10.25835/weuhha72) for reproduction. Vascular disease remains the primary cause of death globally to this day. Tissue damage in these vascular disorders is closely tied to how the diseases develop, which requires careful study. Therefore, the scientific community has dedicated significant efforts to capture the properties of vessel wall fractures. The symmetry-constrained compact tension (symconCT) test combined with digital image correlation (DIC) enabled the study of tissue fracture in various aorta specimens under different conditions. Main purpose of the experiments was to investigate the displacement and strain field ahead of the crack tip. These experimental data were to support the development and verification of computational models. The FEM model used the DIC information for the material parameters identification. Traditionally, the analysis of fracture processes in biological tissues involves extensive computational and experimental efforts due to the complex nature of tissue behavior under stress. These high costs have posed significant challenges, demanding efficient solutions to accelerate research progress and reduce embedded costs. Deep learning techniques have shown promise in overcoming these challenges by learning to indicate patterns and relationships between the input and label data. In this study, we integrate deep learning methodologies with the attention residual U-Net architecture to predict fracture responses in porcine aorta specimens, enhanced with a Monte Carlo dropout technique. By training the network on a sufficient amount of data, the model learns to capture the features influencing fracture progression. These parameterized datasets consist of pictures describing the evolution of tissue fracture path along with the DIC measurements. The integration of deep learning should not only enhance the predictive accuracy, but also significantly reduce the computational and experimental burden, thereby enabling a more efficient analysis of fracture response. [ABSTRACT FROM AUTHOR]

Understanding the relation between the microstructure and the material's effective behavior is an important aspect in inverse computational materials engineering. Especially in the context of localized, inelastic phenomena like plasticity and crack growth, the microstructure morphology plays a crucial role. Due to the stochastic nature of heterogeneous media, a statistical analysis over multiple simulations is necessary, since even with the same material, the simulated crack paths and effective crack lengths are highly dependent on the specific locations of microstructural features. A relevant factor that limits this type of investigation is the high cost of real microstructure data. This work presents a digital workflow for exploring the fracture properties of materials. Therein, the required statistical analyses are facilitated by an algorithm that reconstructs multiple realization of a material structure given a single example. The reconstructed structures are discretized with a regular non-conforming mesh with a diffuse interface and crack representation. Crack phase-field simulations are conducted in order to analyze the effective response. An in-depth introduction to the required methods is given together with a statistical evaluation of the conducted numerical experiments. It is concluded that the statistical variation of the effective material behavior overshadows morphological trends in the presented case. This confirms the relevance and utility of complementing simulation-based workflows with microstructure reconstruction and statistical analyses. [ABSTRACT FROM AUTHOR]

Background: People with coeliac disease (CD) are at increased risk of osteoporosis and fractures. Currently, baseline dual-energy X-ray absorptiometry (DXA) is recommended for all patients with newly diagnosed CD. We aimed to determine the prevalence of osteoporosis and the clinical utility of the Fracture Risk Assessment Tool (FRAX) in predicting major osteoporotic fractures (MOF) in patients with biopsy-proven CD. Methods: We retrospectively collected data for consecutive adult patients with biopsy-proven CD between 2001 and 2015 who underwent DXA scanning within 1 year of diagnosis and were followed up for a minimum of 7 years. Fracture risk was assessed using FRAX scores, and the incidence of major osteoporotic fractures during the follow-up period was analysed. Results: A total of 593 patients (median age 45.0 years, 68.5% female) were included. The prevalence of osteopenia and osteoporosis were 32.3% and 14.5%, respectively. Increasing age (OR 1.06, p <.0001), decreasing BMI (OR 0.90, p =.003), and higher baseline immunoglobulin A-tissue tissue transglutaminase titre (OR 1.04, p =.03) were significantly associated with increased risk of osteoporosis. The sensitivity, specificity, positive and negative predictive values of the FRAX tool to predict MOF were 21.2%, 91.3%, 16.3%, 93.5%, respectively. A higher risk of fractures was associated with ongoing gluten exposure (OR 1.86, p =.02), previous fractures (OR 2.69, p =.005), and older age (OR 1.03, p <.0001). Conclusion: Osteoporosis is a common finding in patients with CD. The FRAX tool showed high specificity in predicting osteoporotic fractures and could be used to aid with patient selection for DXA scanning in some cases. [ABSTRACT FROM AUTHOR]

Introduction: Inpatient and outpatient evaluation is important for management of temporal bone trauma due to the possible otologic complications that can result. However, there is limited literature on follow up rates following temporal bone fracture. This study aimed to determine the proportion of patients lost to follow up after sustaining temporal bone fractures and identify factors associated with loss to follow up. Methods: Retrospective review of adult patients who sustained temporal bone fractures at a level I trauma center from January 1, 2019 to January 1, 2024 was completed (IRB H-44161). The primary outcome included prevalence of patient loss to follow up. Secondary variables included initial radiographic and exam findings, otologic complications, and demographic characteristics. Patients who were seen in follow up and lost to follow up were compared, and odds of loss to follow up was calculated. Results: Sixty-nine patients met inclusion criteria for this study, of which 30 patients (43.5%) were lost to follow up. Patients who were White had a significantly lower odds of loss to follow up than those who were not White (OR = 0.2506 (95% CI: 0.0706, 0.8067, P =.0024). While need for acute management was not significantly different between the groups, a significantly lower proportion of patients who were intubated on presentation (P =.0091), had abnormal otoscopic exam (P =.0211), and had otologic complications (P =.0056) were lost to follow up. Conclusion: Almost half of patients who sustained temporal bone fractures, including a significantly higher odds of minority race/ethnicity patients, were lost to follow up. [ABSTRACT FROM AUTHOR]

Increased fracture risk in type 1 diabetes (T1D) patients is not fully captured by bone mineral density (BMD) by DXA. Advanced glycation end-products (AGEs) have been implicated in the increased fracture risk in T1D, yet recent publications question this. To test the hypothesis that enzymatic collagen cross-links rather than AGEs correlate with fracture incidence in T1D, we analyzed iliac crest biopsies from sex-matched, fracturing T1D patients (N = 5; T1DFx), 6 non-fracturing T1D patients (T1DNoFx), and 6 healthy subjects, by Raman microspectroscopy as a function of tissue age (based on double fluorescent labels), in intracortical and trabecular bone, to determine pyridinoline (Pyd), ε-N-Carboxymethyl-L-lysine, and pentosidine (PEN)). There were no differences in the clinical characteristics between the T1DFx and T1DNoFx groups. At trabecular forming surfaces, T1DFx patients had higher PEN and Pyd content compared to T1DNoFx ones. Previous studies have shown that elevated PEN does not necessarily correlate with fracture incidence in postmenopausal, long-term T1D patients. On the other hand, the elevated Pyd content in the T1DFx patients would be consistent with published studies showing a significant correlation between elevated trivalent enzymatic collagen cross-links and fracture occurrence independent of BMD. Collagen fibers with high Pyd content are more brittle. Thus, a plausible suggestion is that it is the enzymatic collagen cross-links that either by themselves or in combination with the adverse effects of increased AGE accumulation that result in fragility fracture in T1D. [ABSTRACT FROM AUTHOR]

Objective The clinical signs of base of skull fracture (BSF) are often ambiguous and difficult to identify, but are often used to make decisions on early medical interventions. This study aimed to assess the prevalence of the clinical signs of BSF, their dependency to diagnose this injury and to assess the correlation between the presence of these clinical signs and the severity of head injury and patient outcome. Materials and Methods A cross-sectional study was conducted in a tertiary care hospital in South India over a period of 3 years (2020–2023). Patients older than 18 years, with radiological or surgical evidence of BSF were monitored for developing the clinical signs including Battle's signs, raccoon's sign, otorrhea, and rhinorrhea. The presence of these clinical signs was correlated with demographical characteristics, patient presentation, complications, and their outcome. Results A total of 292 patients were included in the study. The mean age of the cohort was 36.27 ± 18.68 years. A total of 55 (18.8%) showed at least one of the four signs of BSF. Raccoon's sign was seen in 9.5% cases, Battle's sign in 5.5%, otorrhea in 5.5%, and rhinorrhea in 2.4% cases. Patients with frontal (p = 0.021) or ethmoid (0.049) fractures and ENT bleeding (p = 0.022) were significantly more likely to present with at least one sign of BSF. The patients who presented with clinical signs were more likely to have a complication during the course of the hospital stay (p = 0.024) than those without clinical signs, including cranial nerve palsy (p < 0.001) and cerebrospinal fluid leak (p < 0.001). The outcome of the patient did not change based on the presence of clinical signs (p = 0.926). Conclusion These study results indicate a limited diagnostic value of BSF clinical signs in the South Indian population. Thus, other modalities should be considered for the diagnosis when suspected. These results also discourage the use of the nasal route in all patients with suspected head injury and emphasize that during the nasal aspiration procedure, the use of a rigid device is fundamental to avoid false passage of the aspiration tube from the nasal to the intracranial region. [ABSTRACT FROM AUTHOR]

Objective: The relationship between spontaneous osteonecrosis of the knee (SONK) and ipsilateral meniscus tear remains to be established, and the possible causes are clarified and summarized. Methods: We conducted a search in Pubmed, Web of Science, Embase, and the Cochrane Library to include all English articles published from the establishment of the database until April 2023. The odds ratio (OR) and 95% confidence interval (CI) were calculated to evaluate the relationship between SONK and ipsilateral meniscus lesions. Results: A total of 405 patients were included in eight articles, including 157 males and 248 females, with an average age of 63.94 years and an average BMI of 26.36 kg/m2. In patients with medial SONK, the prevalence of ipsilateral meniscus tear was 0.8982, 95% CI (0.7389, 0.9648), and the prevalence of ipsilateral posterior root tear was 0.6198, 95% CI (0.5169, 0.7118). The prevalence of ipsilateral meniscus tears in patients with lateral SONK was 0.2188, 95% CI (0.1150, 0.3711), and the prevalence of ipsilateral posterior root tears was 0.1667, 95% CI (0.1071, 0.2424). Conclusions: SONK is significantly associated with meniscus or root tears, which limit meniscus function and lead to changes in the stress environment between the knee and the tibiofemur, increasing the chance of incomplete fracture. We suggest that the expression of SONK can be replaced with subchondral insufficiency fracture of the knee. [ABSTRACT FROM AUTHOR]

Summary: Our study showed that B vitamins did not have significant effect on fracture incidence, bone mineral density, and bone turnover markers. However, the research data of B vitamins on bone mineral density and bone turnover markers are limited, and more clinical trials are needed to draw sufficient conclusions. Purpose: The objective of this study was to identify the efficacy of B vitamin (VB) (folate, B6, and B12) supplements on fracture incidence, bone mineral density (BMD), and bone turnover markers (BTMs). Methods: A comprehensive search was performed in PubMed, MEDLINE, EMBASE, Cochrane databases, and ClinicalTrials.gov up to September 4, 2023. The risk of bias was assessed according to Cochrane Handbook and the quality of evidence was assessed according to the GRADE system. We used trial sequential analysis (TSA) to assess risk of random errors and Stata 14 to conduct sensitivity and publication bias analyses. Results: Data from 14 RCTs with 34,700 patients were extracted and analyzed. The results showed that VBs did not significantly reduce the fracture incidence (RR, 1.06; 95% CI, 0.95 − 1.18; p = 0.33; I2 = 40%) and did not affect BMD in lumbar spine and femur neck. VBs had no significant effect on bone specific alkaline phase (a biomarker for bone formation), but could increase the serum carboxy-terminal peptide (a biomarker for bone resorption) (p = 0.009; I2 = 0%). The TSA showed the results of VBs on BMD and BTMs may not be enough to draw sufficient conclusions due to the small number of sample data included and needed to be demonstrated in more clinical trials. The inability of VBs to reduce fracture incidence has been verified by TSA as sufficient. Sensitivity analysis and publication bias assessment proved that our meta-analysis results were stable and reliable, with no significant publication bias. Conclusions: Available evidence from RCTs does not support VBs can effectively influence osteoporotic fracture risk, BMD, and BTMs. Trial registration: PROSPERO registration number: CRD42023427508. [ABSTRACT FROM AUTHOR]

Summary: The effect of deprivation on total bone health status has not been well defined. We examined the relationship between socioeconomic deprivation and poor bone health and falls and we found a significant association. The finding could be beneficial for current public health strategies to minimise disparities in bone health. Purpose: Socioeconomic deprivation is associated with many illnesses including increased fracture incidence in older people. However, the effect of deprivation on total bone health status has not been well defined. To examine the relationship between socioeconomic deprivation and poor bone health and falls, we conducted a cross-sectional study using baseline measures from the United Kingdom (UK) Biobank cohort comprising 502,682 participants aged 40–69 years at recruitment during 2006–2010. Method: We examined four outcomes: 1) low bone mineral density/osteopenia, 2) fall in last year, 3) fracture in the last five years, and 4) fracture from a simple fall in the last five years. To measure socioeconomic deprivation, we used the Townsend index of the participant's residential postcode. Results: At baseline, 29% of participants had low bone density (T-score of heel < -1 standard deviation), 20% reported a fall in the previous year, and 10% reported a fracture in the previous five years. Among participants experiencing a fracture, 60% reported the cause as a simple fall. In the multivariable logistic regression model after controlling for other covariates, the odds of a fall, fracture in the last five years, fractures from simple fall, and osteopenia were respectively 1.46 times (95% confidence interval [CI] 1.42–1.49), 1.26 times (95% CI 1.22–1.30), 1.31 times (95% CI 1.26–1.36) and 1.16 times (95% CI 1.13–1.19) higher for the most deprived compared with the least deprived quantile. Conclusion: Socioeconomic deprivation was significantly associated with poor bone health and falls. This research could be beneficial to minimise social disparities in bone health. [ABSTRACT FROM AUTHOR]

Improving asphalt mixtures has become increasingly important due to the rise in traffic volume, high maintenance costs, and the challenges associated with their implementation. Previous studies have examined various additives and modifiers. This study investigated the effect of nano Al2O3 on two significant potential damages in asphalt pavements: low-temperature cracking and moisture sensitivity. The results of this study can be used to propose a suitable solution to minimize the probability of these failures occurring in asphalt pavements. Moreover, this study examined the impact of loading modes, temperature, and crack type on the fracture toughness of asphalt mixtures. In addition to exploring pure mode I and pure mode II, four distinct mixed modes (I/II) were also studied because, usually, this mode is the critical mode of the asphalt mixture. Temperature was another variable observed to validate the elasticity of asphalt mixtures at low temperatures. Lastly, the study investigated the effect of incorporating nano Al2O3 on the fracture toughness of the asphalt mixture under different temperatures and crack geometries. To achieve the objectives of this study, the semicircular bending and indirect tensile tests were conducted. The results showed that adding 0.6% nano Al2O3 can increase the crack resistance of asphalt mixtures by up to 12%. Additionally, the study demonstrated that incorporating 0.6% nano Al2O3 can decrease the vulnerability of asphalt mixtures to moisture by 5.1%. The response surface method technique was employed to analyze the laboratory data statistically. A reduced cubic model was utilized to assess the relationship between independent factors (loading mode, temperature, crack type, and nano Al2O3 content) and fracture toughness due to its superior fit with the laboratory results Next, sensitivity analysis was used to find the effect value of each parameter on the fracture toughness of the asphalt mixture. The sensitivity analysis results showed that the loading mode, temperature, crack type, and use of nano Al2O3 , respectively, will significantly impact the fracture toughness of the asphalt mixture. [ABSTRACT FROM AUTHOR]

Aim: Kidney transplant recipients are at high risk of fracture due to many factors such as nutritional status, hyperparathyroidism, acidosis and steroid administration. The current meta‐analysis aimed to comprehensively analyse the incidence and risk factors of fracture in kidney transplant recipients. Methods: A systematic search on Embase, Web of Science, PubMed and Cochrane Library until November 2023 was performed. RStudio software was used to analyse data. Results: Twenty‐eight eligible studies containing 310 530 kidney transplant recipients were included in the analysis. The pooled incidence of fracture was 10% (95% confidence interval [CI]: 7%–13%) generally. When divided by regions, it was further observed that the pooled incidence of fracture was 13% (95% CI: 9%–17%) in Europe, 11% (95% CI: 6%–16%) in North America, 7% (95% CI: 3%–11%) in Asia. Regarding the risk factors, pooled analysis revealed that age of recipient (hazard ratio [HR] = 1.50, 95% CI: 1.17–1.91), female sex (HR = 1.45, 95% CI: 1.36–1.53), pretransplantation diabetes (HR = 1.76, 95% CI: 1.58–1.97), pretransplantation fracture history (HR = 2.28, 95% CI: 1.86–2.78), dialysis duration (HR = 1.09, 95% CI: 1.01–1.17) and deceased donor (HR = 1.21, 95% CI: 1.05–1.39) related to higher risk of fracture. The general quality of included studies was acceptable, and no publication bias existed except for the analysis between age of recipient and fracture incidence; further trim and fill method indicated age of recipient showed a correlation trend with the fracture incidence without the statistical significance. Conclusion: The pooled incidence of fracture reaches 10% in kidney transplant recipients, which relates to age of recipient, female sex, pretransplantation diabetes or fracture history, dialysis duration and decease donor. [ABSTRACT FROM AUTHOR]

Summary: This case series describes three cases of osseous cyst‐like lesions of the proximal phalanx (P1), which were associated with a complete fracture. The fractures and osseous cyst‐like lesions were analysed through radiographic and computed tomographic (CT) images for fracture configuration and prodromal factors, such as subchondral sclerosis and periosteal new bone formation. Internal stabilisation was performed in all cases through placing transcortical bone screws under CT guidance. In conclusion, the presence of osseous cyst‐like lesions in the proximal P1 as well as the addition of prodromal markers, such as localised periosteal new bone formation and subchondral bone sclerosis, suggest pathological subchondral bone with the potential to fracture and stabilisation should be prioritised. [ABSTRACT FROM AUTHOR]

Phase-field models of brittle fracture are typically endowed with a decomposition of the elastic strain energy density in order to realistically describe fracture under multi-axial stress states. In this contribution, we identify the essential requirements for this decomposition to correctly describe both nucleation and propagation of cracks. Discussing the evolution of the elastic domains in the strain and stress spaces as damage evolves, we highlight the links between the nucleation and propagation conditions and the modulation of the elastic energy with the phase-field variable. In light of the identified requirements, we review some of the existing energy decompositions, showcasing their merits and limitations, and conclude that none of them is able to fulfil all requirements. As a partial remedy to this outcome, we propose a new energy decomposition, denoted as star-convex model, which involves a minimal modification of the volumetric-deviatoric decomposition. Predictions of the star-convex model are compared with those of the existing models with different numerical tests encompassing both nucleation and propagation. [ABSTRACT FROM AUTHOR]

Study design. This was a retrospective cohort study. Objective. To determine the proportion of referrals diverted by the spine virtual fracture clinic (SVFC) from traditional outpatient clinic management. Summary of background data. The consistent rise in demand for orthopedic outpatient clinic services is creating marked challenges to the provision of quality care. Virtual fracture clinics for upper and lower limb fractures have reduced the burden on outpatient clinics by providing an alternative telehealth management pathway. To date, no study describes the expansion of virtual care to the spine trauma population. Methods. A study of spine fractures referred to the RMH Department of Orthopaedic Surgery was conducted comparing outcomes before (January to December 2021) and following (July 2022 to November 2023) implementation of an SVFC. The primary aim of this study was to investigate the effect of a telephonebased SVFC on outpatient clinic activity, represented by the proportion of referrals discharged without requiring an outpatient clinic appointment. Secondary aims included appointment utilization, lost to follow-up rates, duration of care, missed or misdiagnoses, unplanned operations, and complications. Results. Of the 731 referrals managed by the SVFC, 91.1% were discharged without requiring in-person outpatient clinic attendance. Compared with the outpatient clinic historical cohort (150 referrals), SVFC management was associated with reductions in the average number of consultations per referral (1.8 vs. 2.4, P< 0.001), appointments not attended (5% vs. 13%, P<0.001), referrals lost to follow-up (0% vs. 10.7%, P<0.001), and a shorter duration of care (median 48 vs. 58 d, P< 0.001). A total of 65 patients (8.1%) were redirected to the outpatient clinic, of which three underwent surgical intervention. No diagnostic errors, complications or adverse events were identified. Conclusion. This study demonstrates that an SVFC is an effective and safe alternative pathway to traditional hospital-based outpatient clinics, ith low-risk for any adverse outcomes. [ABSTRACT FROM AUTHOR]

The intersection of dynamic compression, high-rate material response and X-ray science has seen rapid growth, leading to the establishment of specialized end-stations at international facilities such as Linac Coherent Light Source LCLS (Matter at Extreme Conditions – MEC) and Advanced Photon Source APS (Dynamic Compression Sector – DCS), both USA. Although these facilities excel in working with X-rays tailored for small material volumes (i.e. $\lt 1\, {\rm mm}^3$ < 1 mm 3 ), it needs a different approach to delve into subsequent processes. This is particularly the case in the transition from the micro- to mesoscale: here the ESRF distinguishes itself. The large beam size (several cm2) of the ID19 beamline, in conjunction with a strong high energy component, source flux density, and outstanding imaging sensitivity, enables sub-surface visualization of engineering-scale structures as well as natural systems in representative volume, under high rate and shock. This is particularly valuable when studying materials with complex mesostructures and heterogeneities on relevant volumetric scales, which often dominate the dynamic material response. The study of the behavior of materials under dynamic loading presents a unique challenge due to inherently spanning over multiple lengths- and timescales. The evolution of sudden (thermo)mechanical excitation, starting from the lattice scale and progressing through grains, phase domains, and ultimately to structures, exhibits a spectrum of responses spanning from the microscopic to bulk length scales. Consequently, a diverse range of diagnostics as well as driver instrumentation is required to identify, study, and characterize this material response spectrum. This article shall introduce platforms available at beamline ID19 and underline their potential by selected showcase applications. Community access proposals such as the beamtime Block Allocation Group (BAG) allow for access in a routine manner. [ABSTRACT FROM AUTHOR]

Current protocols on cervical immobilization postcervical spine fracture are widely accepted in the acute rehabilitation of older adults, however consensus on its overall effectiveness remains lacking. Summarize information from original studies on available cervical immobilization protocols following a cervical fracture and to answer the questions; Which types of study designs have been used to assess the effectiveness of these protocols? What are the currently reported cervical immobilization protocols following cervical fracture in adults? What is the effectiveness of these protocols? What adverse events are associated with these protocols? Scoping review was performed. Searches were performed on the following online databases from inception to February 23, 2023: EMBASE, MEDLINE, CINAHL, and CENTRAL. Databases were searched for articles pertaining to collar use post cervical spine fracture. Effectiveness of the cervical fracture immobilization protocols was the primary outcome, examined by various measures including union rates and disability indexes. 4 databases were searched; EMBASE, MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane Central Register of Controlled Trials (CENTRAL) beginning on February 23, 2023, where 5,127 studies were yielded and 32 were extracted based on studies of adults (≥18 years) with a diagnosis of a cervical fracture (C0–C7) managed with a rigid external orthosis to prevent instability and surgery (collar, or cervicothoracic orthosis). Risk of bias was assessed using the guidelines set out by the Joanna Briggs Institute. This scoping review yielded low-level prospective (18%) and retrospective (69%) cohort studies, case-control studies (3%), and case series (6%) from 1987 to 2022, patient age ranged from 14 to 104 years. Findings were difficult to summarize based on the lack of randomized controlled trials, leading to no clear conclusions drawn on the presence of standardized cervical immobilization protocols with no information on the duration of treatment or transition in care. Most included articles were retrospective cohort studies of poor to moderate quality, which have significant risk of bias for intervention questions. The effectiveness of these protocols remains unclear as most studies evaluated heterogeneous outcomes and did not present between-group differences. Mortality, musculoskeletal (MSK) complications, and delayed surgery were common adverse events associated with cervical collar use. This scoping review highlights the need for higher levels of evidence as there is currently no standardized immobilization protocol for cervical spine fractures as a primary treatment, the effectiveness of cervical immobilization protocols is unclear, and mortality, MSK complications, and delayed surgery are common adverse events. No sources of funding were used for this scoping review. [ABSTRACT FROM AUTHOR]