Fatigue fractures in military conscripts : A study on risk factors, diagnostics and long-term consequences

Fatigue fracture is an overuse injury commonly encountered in military and sports medicine, and known to relate to intensive or recently intensified physical activity. Bone responds to increased stress by enhanced remodeling. If physical stress exceeds bone s capability to remodel, accumulation of microfractures can lead to bone fatigue and stress fracture. Clinical diagnosis of stress fractures is complex and based on patient s anamnesis and radiological imaging. Bone stress fractures are mostly low-risk injuries, healing well after non-operative management, yet, occurring in high-risk areas, stress fractures can progress to displacement, often necessitating surgical treatment and resulting in prolonged morbidity. In the current study, the role of vitamin D as a predisposing factor for fatigue fractures was assessed using serum 25OHD level as the index. The average serum 25OHD concentration was significantly lower in conscripts with fatigue fracture than in controls. Evaluating TRACP-5b bone resorption marker as indicator of fatigue fractures, patients with elevated serum TRACP-5b levels had eight times higher probability of sustaining a stress fracture than controls. Among the 154 patients with exercise induced anterior lower leg pain and no previous findings on plain radiography, MRI revealed a total of 143 bone stress injuries in 86 patients. In 99% of the cases, injuries were in the tibia, 57% in the distal third of the tibial shaft. In patients with injury, forty-nine (57%) patients exhibited bilateral stress injuries. In a 20-year follow-up, the incidence of femoral neck fatigue fractures prior to the Finnish Defence Forces new regimen in 1986 addressing prevention of these fractures was 20.8/100,000, but rose to 53.2/100,000 afterwards, a significant 2.6-fold increase. In nineteen subjects with displaced femoral neck fatigue fractures, ten early local complications (in first postoperative year) were evident, and after the first postoperative year, osteonecrosis of the femoral head in six and osteoarthritis of the hip in thirteen patients were found. It seems likely that low vitamin D levels are related to fatigue fractures, and that an increasing trend exists between TRACP-5b bone resorption marker elevation and fatigue fracture incidence. Though seldom detected by plain radiography, fatigue fractures often underlie unclear lower leg stress-related pain occurring in the distal parts of the tibia. Femoral neck fatigue fractures, when displaced, lead to long-term morbidity in a high percentage of patients, whereas, when non-displaced, they do not predispose patients to subsequent adverse complications. Importantly, an educational intervention can diminish the incidence of fracture displacement by enhancing awareness and providing instructions for earlier diagnosis of fatigue fractures.

Elimination of axial venous reflux

Chronic venous disease (CVD), including uncomplicated varicose veins and chronic venous insufficiency, is one of the most common medical conditions in the Western world. The central feature of CVD is venous reflux, which may be primary, congenital, or result from an antecedent event, usually an acute deep venous thrombosis (DVT). When the history of DVT is clear, the clinical manifestations of secondary CVD are commonly referred to as the post-thrombotic syndrome. Regardless of the underlying etiology, the final pathway leading to symptoms is ambulatory venous hypertension. The spectrum of symptoms and signs of CVD ranges from minor cosmetic problems to venous ulceration, which results in considerable morbidity and increased medical costs. Aims of this study were to evaluate the outcome of superficial venous surgery performed with or without preoperative duplex evaluation and venous marking with hand-held doppler, to assess short-term outcome of ultrasound-guided foam sclerotherapy in patients with axial superficial venous incompetence, as well as to compare reflux patterns after catheter-directed and systemic thrombolysis of deep ileofemoral venous thrombosis, and to evaluate the long-term outcome of deep venous reconstructions for severe chronic venous insufficiency. The study consists of five separate retrospective projects and includes 315 patients. Of this, 133 patients had undergone superficial venous surgery 2 to 5 years earlier according to preoperative duplex examination and venous marking, or according to clinical evaluation alone, or to a written plan without venous marking. A total of 112 patients had undergone ultrasound-guided foam sclerotherapy 5.5 to 16.5 months before. In addition, 32 patients had received either catheter-directed or systemic thrombolysis for DVT 2 to 3 years earlier, and 38 patients had undergone deep venous reconstructions 2 to 7 years earlier. In the present studies, some venous reflux was present postoperatively irrespective of the method of evaluation or ablation of the reflux. It seemed, however, that preoperative examination with duplex ultrasound and marking of reflux sites before the operation by the operating surgeon improves the outcome of superficial venous surgery. Ultrasound-guided foam sclerotherapy is effective in elimination of venous reflux in selected cases in short-term follow-up. Catheter-directed thrombolysis for deep iliofemoral venous thrombosis reduces later reflux and most probably the development of post-thrombotic syndrome as well. The outcome of deep venous reconstructions, especially for post-thrombotic deep venous incompetence, is poor. Thus, prevention of valvular damage by active treatment of deep venous thrombosis is important.

Assessment of the residual fatigue strength in RC beams

In conventional analysis and design procedures of reinforced concrete structures, the ability of concrete to resist tension is neglected. Under cyclic loading, the tension-softening behavior of concrete influences its residual strength and subsequent crack propagation. The stability and the residual strength of a cracked reinforced concrete member under fatigue loading, depends on a number of factors such as, reinforcement ratio, specimen size, grade of concrete, and the fracture properties, and also on the tension-softening behavior of concrete. In the present work, a method is proposed to assess the residual strength of a reinforced concrete member subjected to cyclic loading. The crack extension resistance based approach is used for determining the condition for unstable crack propagation. Three different idealization of tension softening models are considered to study the effect of post-peak response of concrete. The effect of reinforcement is modeled as a closing force counteracting the effect of crack opening produced by the external moment. The effect of reinforcement percentage and specimen size on the failure of reinforced beams is studied. Finally, the residual strength of the beams are computed by including the softening behavior of concrete.

Near-threshold fatigue crack growth in bulk metallic glass composites

A major drawback in using bulk metallic glasses (BMGs) as structural materials is their extremely poor fatigue performance. One way to alleviate this problem is through the composite route, in which second phases are introduced into the glass to arrest crack growth. In this paper, the fatigue crack growth behavior of in situ reinforced BMGs with crystalline dendrites, which are tailored to impart significant ductility and toughness to the BMG, was investigated. Three composites, all with equal volume fraction of dendrite phases, were examined to assess the influence of chemical composition on the near-threshold fatigue crack growth characteristics. While the ductility is enhanced at the cost of yield strength vis-a-vis that of the fully amorphous BMG, the threshold stress intensity factor range for fatigue crack initiation in composites was found to be enhanced by more than 100%. Crack blunting and trapping by the dendritic phases and constraining of the shear bands within the interdendritic regions are the micromechanisms responsible for this enhanced fatigue crack growth resistance.

Impact of chemotherapy on cancer-related fatigue and cytokines in 1312 patients: A systematic review of quantitative studies

Purpose of review: Cancer-related fatigue (CRF) is the most common psychosomatic distress experienced by cancer patients before, during and after chemotherapy. Its impact on functional status and Health Related Quality of Life is a great concern among patients, healthcare professionals and researchers. The primary objective of this systematic review is to determine whether the different chemotherapies affect the association of CRF with individual pro- and anti-inflammatory cytokines. The PRISMA statement guideline has been followed to systematically search and screen article from PubMed and Embase. Recent findings: This review has examined 14 studies which included a total of 1312 patients. These studies assayed 20 different kinds of cytokines. The cytokines interleukin-6, interleukin-1RA, TGF-[beta] and sTNF-R2 were associated with CRF in patients receiving anthracycline-based chemotherapy. However, only interleukin-13 was identified in the taxane-based chemotherapy. Similarly, different sets of cytokines were linked with CRF in patients with chemotherapy regimens containing platinum, cyclophosphamides, topotecan or bleomycin. Summary: This review has identified that cytokines are differentially linked with CRF according to the various types of chemotherapy regimens.

Prediction of fatigue strength in plain and reinforced concrete beams

A fatigue crack propagation model for concrete is proposed based on the concepts of fracture mechanics. This model takes into account the loading history, frequency of applied load, and size, effect parameters. Using this model, a method is described based on linear elastic fracture mechanics to assess the residual strength of cracked plain and reinforced concrete (RC) beams. This could be used to predict the residual strength (load carrying capacity) of cracked or damaged plain and reinforced concrete beams at a given level of damage. It has been seen that the fatigue crack propagation rate increases as. the size of plain concrete, beam increases indicating an increase in brittleness. In reinforced concrete (RC) beams, the fracture process becomes stable only when the beam is sufficiently reinforced.

Flow of an electrically conducting non-newtonian fluid between two rotating coaxial cones in the presence of external magnetic field due to an axial current

Bhatnagar and Rathna (Quar. Journ. Mech. Appl. Maths., 1963,16, 329) investigated the flows of Newtonian, Reiner-Rivlin and Rivlin-Ericksen fluids between two rotating coaxial cones. In case of the last two types of fluids, they predicted the breaking of secondary flow field in any meridian plane. We find that such breaking is avoided by the application of a sufficiently strong azimuthal magnetic field arising from a line current along the axis of the cones.

Harmonic and anharmonic oscillations of a cylindrical plasma in the presence of a uniform axial magnetic field and a steady axial current

In the present note we have studied the harmonic and anharmonic oscillations of cylindrical plasma using Lagrangian formalism. In order to study the harmonic oscillations, the equations are linearized and the resulting equation for the displacement has been numerically solved. For situations present in thermonuclear reactors, the presence of axial magnetic field is found necessary to make the periods of oscillation to become comparable with the time required for the thermonuclear reactions to set in. A detailed analysis of the anharmonic oscillations reveals that the significant interaction is between the first and the second mode. The fundamental period of anharmonic oscillation is more than the corresponding period of harmonic oscillations by 9·2%. Graphs have been drawn for the amplitudes of relative variations in density and magnetic field and of the time-varying part of anharmonic oscillation.

Fatigue crack propagation in rocker and roller–rocker bearings of railway steel bridges

In this work, a method is proposed for rolling contact fatigue crack propagation analysis using contact and fracture theories in conjunction with fatigue laws. The proposed method is used in the fatigue analysis of rocker and roller–rocker bearings of a railway open web girder bridge which is instrumented with strain gages. Using a contact algorithm based on the minimum energy principle for bodies in rolling contact with dry friction, the normal and tangential pressure distribution are computed. It is seen that the most critical location of a crack in bearings is at a point very close to the contact region, as expected.

Fatigue crack propagation in rocker and roller-rocker bearings of railway steel bridges

In this work, a method is proposed for rolling contact fatigue crack propagation analysis using contact and fracture theories in conjunction with fatigue laws. The proposed method is used in the fatigue analysis of rocker and roller-rocker bearings of a railway open web girder bridge which is instrumented with strain gages. Using a contact algorithm based on the minimum energy principle for bodies in rolling contact with dry friction, the normal and tangential pressure distribution are computed. It is seen that the most critical location of a crack in bearings is at a point very close to the contact region, as expected. (C) 2010 Elsevier Ltd. All rights reserved.

Effect of copper addition on the fracture and fatigue crack growth behavior of solution heat-treated SUS 304H austenitic steel

Small additions of Cu to the SUS 304H, a high temperature austenitic stainless steel, enhance its high temperature strength and creep resistance. As Cu is known to cause embrittlement, the effect of Cu on room temperature mechanical properties that include fracture toughness and fatigue crack threshold of as-solutionized SUS 304H steel were investigated in this work. Experimental results show a linear reduction in yield and ultimate strengths with Cu addition of up to 5 wt.% while ductility drops markedly for 5 wt.% Cu alloy. However, the fracture toughness and the threshold stress intensity factor range for fatigue crack initiation were found to be nearly invariant with Cu addition. This is because the fracture in this alloy is controlled by the debonding from the matrix of chromium carbide precipitates, as evident from fractography. Cu, on the other hand, remains either in solution or as nano-precipitates and hence does not influence the fracture characteristics. It is concluded that small additions of Cu to 304H will not have adverse effects on its fracture and fatigue behavior. (C) 2010 Elsevier B.V. All rights reserved.