923 resultados para TIBIAL FRACTURES


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This study was performed to characterize evidence of potential unconformity-type U mineralizing fluids in drill core fractures from the Stewardson Lake prospect, in the Athabasca Basin, located in Northern Saskatchewan and Alberta, Canada. Fractures were visually classified into eight varieties. This classification scheme was improved with the use of mineralogical characterization through SEM (Scanning Electron Microscope) and XRD analyses of the fracture fills and resulted in the identification of various oxides, hydroxides, sulfides, and clays or clay-sized minerals. Fractures were tallied to a total of ten categories with some commonalities in color. The oxidative, reductive or mixed nature of the fluids interacting with each fracture was determined based on its fill mineralogy. The measured Pb isotopic signature of samples was used to distinguish fractures affected solely by fluids emanating from a U mineralization source, from those affected by mixed fluids. Anomalies in U and U-pathfinder elements detected in fractures assisted with attributing them to the secondary dispersion halo of potential mineralization. Three types of fracture functions (chimney, composite and drain) were defined based on their interpreted flow vector and history. A secondary dispersion halo boundary with a zone of dominance of infiltrating fluids was suggested for two boreholes. The control of fill mineralogy on fracture color was investigated and the indicative and non-indicative colors and minerals, with respect to a secondary dispersion halo, were formally described. The fracture colors and fills indicative of proximity to the basement host of the potential mineralization were also identified. In addition, three zones of interest were delineated in the boreholes with respect to their geochemical dynamics and their relationship to the potential mineralization: a shallow barren overburden zone, a dispersion and alteration zone at intermediate depth, and a second deeper zone of dispersion and alteration.

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Uma das causas de insucesso nas artroplastias do joelho está relacionada com a dor que os doentes sentem a curto e/ou longo prazo. A dor tanto pode ser devida a infecção ou descolamento, como pode estar presente sem qualquer um destes factores, provocando a substituição da prótese. Existem estudos de origem clínica que relatam uma percentagem, que se pode considerar relevante, de dor na extremidade da haste, quer na zona da tíbia quer no fémur [1-3]. A nível ósseo, a cintigrafia pode mostrar as alterações metabólicas locais, antes de qualquer tradução radiográfica [4]. O aumento da carga, a nível ósseo, estimula localmente a actividade osteoblástica [4]. Esta estimulação pode originar dor local, como demonstrado num caso clínico por Fonseca et al. [5], referente a um doente com dor na extremidade da haste de uma prótese do joelho e onde a cintigrafia com Tc 99m [5] mostrava uma actividade celular mais intensa em torno da extremidade. O presente estudo teve como objectivo verificar até que ponto é possível estabelecer uma relação entre o sintoma dor e o comportamento biomecânico da haste da prótese do joelho e, particularmente, na sua extremidade. A análise relativa ao nível de tensões no osso, em torno da haste tibial, comparativamente ao valor do osso intacto para o mesmo tipo de carga e localização, foi realizada utilizando a aplicação de análise estrutural HyperWorks (Altair Engineering Inc.). Um estudo posterior, relativo à forma e material da extremidade da haste levou à conclusão de que é possível uma melhor uniformização das tensões no osso, podendo-se desta forma aproximar às tensões fisiológicas. Neste sentido, a forma geometral da haste deverá ser objecto de optimização, que poderá incluir materiais poliméricos, de menor rigidez, na ponta distal do implante.

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Abstract: The first metatarsal sesamoid bones are not always taken into consideration when making a diagnosis, in pathologies that affect the region of the first metatarsal head. This is due to the insufficient knowledge of all the pathologies that can affect the sesamoids and the relative little incidence that they have. With the increment of sports activities, in particular the running, increasingly affects of the symptoms concerning this region are observed. Methods: A literature search was performed in 5 databases (Medline, PubMed, Scopus, Cochrane Library and BUCEA). The terms included in the search were: sesamoids, anatomy, biomechanics, sesamoids review and sesamoids pathology. In the initial search articles with no more than 10 years, only humans and revision texts are considered. Results: 24 articles were selected and include different pathologies with diagnosis using imaging tests and treatments, both conservative and surgical; as well as aspects from the biomechanics of the metatarsal-sesamoid joint. Conclusion: Sesamoids due of his anatomy, topography and function can be involved in a lot of pathologies; with similar signs and symptoms that can confuse the podiatry when he has to make a correct diagnosis or treatment.

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International audience

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Electrical impedance tomography is applied to the problem of detecting, locating, and tracking fractures in ballistics gelatin. The hardware developed is intended to be physically robust and based on off-the-shelf hardware. Fractures were created in two separate ways: by shooting a .22 caliber bullet into the gelatin and by injecting saline solution into the gelatin. The .22 caliber bullet created an air gap, which was seen as an increase in resistivity. The saline solution created a fluid filled gap, which was seen as a decrease in resistivity. A double linear array was used to take data for each of the fracture mechanisms and a two dimensional cross section was inverted from the data. The results were validated by visually inspecting the samples during the fracture event. It was found that although there were reconstruction errors present, it was possible to reconstruct a representation of the resistive cross section. Simulations were performed to better understand the reconstructed cross-sections and to demonstrate the ability of a ring array, which was not experimentally tested.

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Les méthodes d'opération permettant la stabilisation temporaire de fractures du fémur ont peu changé dans les dernières décennies. Ce mémoire illustre d'abord les différentes techniques chirurgicales présentement utilisées. Ces dernières sont principalement des outils manuels très simples. Un survol des recherches universitaires sur le sujet démontre que l'effort se porte principalement sur des manipulateurs robotisés complexes qui sont peu susceptibles d'être utilisés dans les salles d'opération à court terme. Avec l'aide de chirurgiens, il a été possible de connaître les besoins de ceux-ci en ce qui concerne la réduction et la stabilisation de fractures. Un appareil mécanique transparent à la radiographie a été conçu. Pour ce faire, plusieurs éléments de machine et mécanismes ont dû être développés en matériaux plastiques ou composites. L'appareil permet aux chirurgiens de déplacer un des fragments de l'os dans les six degrés de liberté puis de le maintenir stable. Un prototype a été fabriqué. Des essais avec un simulateur de fracture ont permis de récolter les commentaires de chirurgiens.

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In this study, the lubrication theory is used to model flow in geological fractures and analyse the compound effect of medium heterogeneity and complex fluid rheology. Such studies are warranted as the Newtonian rheology is adopted in most numerical models because of its ease of use, despite non-Newtonian fluids being ubiquitous in subsurface applications. Past studies on Newtonian and non-Newtonian flow in single rock fractures are summarized in Chapter 1. Chapter 2 presents analytical and semi-analytical conceptual models for flow of a shear-thinning fluid in rock fractures having a simplified geometry, providing a first insight on their permeability. in Chapter 3, a lubrication-based 2-D numerical model is first implemented to solve flow of an Ellis fluid in rough fractures; the finite-volumes model developed is more computationally effective than conducting full 3-D simulations, and introduces an acceptable approximation as long as the flow is laminar and the fracture walls relatively smooth. The compound effect of shear-thinning fluid nature and fracture heterogeneity promotes flow localization, which in turn affects the performance of industrial activities and remediation techniques. In Chapter 4, a Monte Carlo framework is adopted to produce multiple realizations of synthetic fractures, and analyze their ensemble statistics pertaining flow for a variety of real non-Newtonian fluids; the Newtonian case is used as a benchmark. In Chapter 5 and Chapter 6, a conceptual model of the hydro-mechanical aspects of backflow occurring in the last phase of hydraulic fracturing is proposed and experimentally validated, quantifying the effects of the relaxation induced by the flow.

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Purpose. To determine the mechanisms predisposing penile fracture as well as the rate of long-term penile deformity and erectile and voiding functions. Methods. All fractures were repaired on an emergency basis via subcoronal incision and absorbable suture with simultaneous repair of eventual urethral lesion. Patients' status before fracture and voiding and erectile functions at long term were assessed by periodic follow-up and phone call. Detailed history included cause, symptoms, and single-question self-report of erectile and voiding functions. Results. Among the 44 suspicious cases, 42 (95.4%) were confirmed, mean age was 34.5 years (range: 18-60), mean follow-up 59.3 months (range 9-155). Half presented the classical triad of audible crack, detumescence, and pain. Heterosexual intercourse was the most common cause (28 patients, 66.7%), followed by penile manipulation (6 patients, 14.3%), and homosexual intercourse (4 patients, 9.5%). Woman on top was the most common heterosexual position (n = 14, 50%), followed by doggy style (n = 8, 28.6%). Four patients (9.5%) maintained the cause unclear. Six (14.3%) patients had urethral injury and two (4.8%) had erectile dysfunction, treated by penile prosthesis and PDE-5i. No patient showed urethral fistula, voiding deterioration, penile nodule/curve or pain. Conclusions. Woman on top was the potentially riskiest sexual position (50%). Immediate surgical treatment warrants long-term very low morbidity.

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Sexual dysfunction (SD) affects up to 80% of multiple sclerosis (MS) patients and pelvic floor muscles (PFMs) play an important role in the sexual function of these patients. The objective of this paper is to evaluate the impact of a rehabilitation program to treat lower urinary tract symptoms on SD of women with MS. Thirty MS women were randomly allocated to one of three groups: pelvic floor muscle training (PFMT) with electromyographic (EMG) biofeedback and sham neuromuscular electrostimulation (NMES) (Group I), PFMT with EMG biofeedback and intravaginal NMES (Group II), and PFMT with EMG biofeedback and transcutaneous tibial nerve stimulation (TTNS) (Group III). Assessments, before and after the treatment, included: PFM function, PFM tone, flexibility of the vaginal opening and ability to relax the PFMs, and the Female Sexual Function Index (FSFI) questionnaire. After treatment, all groups showed improvements in all domains of the PERFECT scheme. PFM tone and flexibility of the vaginal opening was lower after the intervention only for Group II. All groups improved in arousal, lubrication, satisfaction and total score domains of the FSFI questionnaire. This study indicates that PFMT alone or in combination with intravaginal NMES or TTNS contributes to the improvement of SD.

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Seizures in some 30% to 40% of patients with epilepsy fail to respond to antiepileptic drugs or other treatments. While much has been made of the risks of new drug therapies, not enough attention has been given to the risks of uncontrolled and progressive epilepsy. This critical review summarizes known risks associated with refractory epilepsy, provides practical clinical recommendations, and indicates areas for future research. Eight international epilepsy experts from Europe, the United States, and South America met on May 4, 2013, to present, review, and discuss relevant concepts, data, and literature on the consequences of refractory epilepsy. While patients with refractory epilepsy represent the minority of the population with epilepsy, they require the overwhelming majority of time, effort, and focus from treating physicians. They also represent the greatest economic and psychosocial burdens. Diagnostic procedures and medical/surgical treatments are not without risks. Overlooked, however, is that these risks are usually smaller than the risks of long-term, uncontrolled seizures. Refractory epilepsy may be progressive, carrying risks of structural damage to the brain and nervous system, comorbidities (osteoporosis, fractures), and increased mortality (from suicide, accidents, sudden unexpected death in epilepsy, pneumonia, vascular disease), as well as psychological (depression, anxiety), educational, social (stigma, driving), and vocational consequences. Adding to this burden is neuropsychiatric impairment caused by underlying epileptogenic processes (essential comorbidities), which appears to be independent of the effects of ongoing seizures themselves. Tolerating persistent seizures or chronic medicinal adverse effects has risks and consequences that often outweigh risks of seemingly more aggressive treatments. Future research should focus not only on controlling seizures but also on preventing these consequences.

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The Subaxial Injury Classification (SLIC) system and severity score has been developed to help surgeons in the decision-making process of treatment of subaxial cervical spine injuries. A detailed description of all potential scored injures of the SLIC is lacking. We performed a systematic review in the PubMed database from 2007 to 2014 to describe the relationship between the scored injuries in the SLIC and their eventual treatment according to the system score. Patients with an SLIC of 1-3 points (conservative treatment) are neurologically intact with the spinous process, laminar or small facet fractures. Patients with compression and burst fractures who are neurologically intact are also treated nonsurgically. Patients with an SLIC of 4 points may have an incomplete spinal cord injury such as a central cord syndrome, compression injuries with incomplete neurologic deficits and burst fractures with complete neurologic deficits. SLIC of 5-10 points includes distraction and rotational injuries, traumatic disc herniation in the setting of a neurological deficit and burst fractures with an incomplete neurologic deficit. The SLIC injury severity score can help surgeons guide fracture treatment. Knowledge of the potential scored injures and their relationships with the SLIC are of paramount importance for spine surgeons who treated subaxial cervical spine injuries.

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To evaluate the outcomes in patients treated for humerus distal third fractures with MIPO technique and visualization of the radial nerve by an accessory approach, in those without radial palsy before surgery. The patients were treated with MIPO technique. The visualization and isolation of the radial nerve was done by an approach between the brachialis and the brachiorradialis, with an oblique incision, in the lateral side of the arm. MEPS was used to evaluate the elbow function. Seven patients were evaluated with a mean age of 29.8 years old. The average follow up was 29.85 months. The radial neuropraxis after surgery occurred in three patients. The sensorial recovery occurred after 3.16 months on average and also of the motor function, after 5.33 months on average, in all patients. We achieved fracture consolidation in all patients (M=4.22 months). The averages for flexion-extension and prono-supination were 112.85° and 145°, respectively. The MEPS average score was 86.42. There was no case of infection. This approach allowed excluding a radial nerve interposition on site of the fracture and/or under the plate, showing a high level of consolidation of the fracture and a good evolution of the range of movement of the elbow. Level of Evidence IV, Case Series.

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The aim of this retrospective study was to compare the peculiarities of maxillofacial injuries caused by interpersonal violence with other etiologic factors. Medical records of 3,724 patients with maxillofacial injuries in São Paulo state (Brazil) were retrospectively analyzed. The data were submitted to statistical analysis (simple descriptive statistics and Chi-squared test) using SPSS 18.0 software. Data of 612 patients with facial injuries caused by violence were analyzed. The majority of the patients were male (81%; n = 496), with a mean age of 31.28 years (standard deviation of 13.33 years). These patients were more affected by mandibular and nose fractures, when compared with all other patients (P < 0.01), although fewer injuries were recorded in other body parts (χ(2) = 17.54; P < 0.01); Victims of interpersonal violence exhibited more injuries when the neurocranium was analyzed in isolation (χ(2) = 6.85; P < 0.01). Facial trauma due to interpersonal violence seem to be related to a higher rate of facial fractures and lacerations when compared to all patients with facial injuries. Prominent areas of the face and neurocranium were more affected by injuries.

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Maxillofacial trauma resulting from falls in elderly patients is a major social and health care concern. Most of these traumatic events involve mandibular fractures. The aim of this study was to analyze stress distributions from traumatic loads applied on the symphyseal, parasymphyseal, and mandibular body regions in the elderly edentulous mandible using finite-element analysis (FEA). Computerized tomographic analysis of an edentulous macerated human mandible of a patient approximately 65 years old was performed. The bone structure was converted into a 3-dimensional stereolithographic model, which was used to construct the computer-aided design (CAD) geometry for FEA. The mechanical properties of cortical and cancellous bone were characterized as isotropic and elastic structures, respectively, in the CAD model. The condyles were constrained to prevent free movement in the x-, y-, and z-axes during simulation. This enabled the simulation to include the presence of masticatory muscles during trauma. Three different simulations were performed. Loads of 700 N were applied perpendicular to the surface of the cortical bone in the symphyseal, parasymphyseal, and mandibular body regions. The simulation results were evaluated according to equivalent von Mises stress distributions. Traumatic load at the symphyseal region generated low stress levels in the mental region and high stress levels in the mandibular neck. Traumatic load at the parasymphyseal region concentrated the resulting stress close to the mental foramen. Traumatic load in the mandibular body generated extensive stress in the mandibular body, angle, and ramus. FEA enabled precise mapping of the stress distribution in a human elderly edentulous mandible (neck and mandibular angle) in response to 3 different traumatic load conditions. This knowledge can help guide emergency responders as they evaluate patients after a traumatic event.