Interobserver reliability of coronoid fracture classification : two-dimensional versus three-dimensional computed tomography

Purpose : This study tests the hypothesis that 3-dimensional computed tomography (CT) reconstructions improve interobserver agreement on classification and treatment of coronoid fractures compared with 2-dimensional CT.

Methods : A total of 29 orthopedic surgeons evaluated 10 coronoid fractures on 2 occasions (first with radiographs and 2-dimensional CT and then with radiographs and 3-dimensional CT), separated by a minimum of 2 weeks. Surgeons classified fractures according to the classifications of Regan and Morrey and of O'Driscoll et al., identified specific characteristics, recommended the most appropriate treatment approach, and made treatment recommendations. The kappa multirater measure (κ) was calculated to estimate agreement between observers.

Results : Regardless of the imaging modality used, there was fair to moderate agreement for most of the observations. Three-dimensional CT improved interobserver agreement in Regan and Morrey's classsication (κ3-dimensional = 0.51 vs κ2-dimensional = 0.40; p < .001) and O'Driscoll et al.'s classifications (κ3-dimensional = 0.48 vs κ2-dimensional = 0.42; p = .009). There were trends toward better reliability for 3-dimensional reconstruction in recognition of coronoid tip fractures (κ3-dimensional = 0.19, κ2-dimensional = 0.03; p = .268), comminution (κ3-dimensional = 0.41 vs κ2-dimensional = 0.29; p = .133), and impacted fragments (κ3-dimensional = 0.39 vs κ2-dimensional = 0.27; p = .094), and in surgeons' opinions on the need for something other than screws or plate for surgical fixation (κ3-dimensional = 0.31 vs κ2-dimensional = 0.15; p = .138). Interobserver agreement on treatment approach was better with 2-dimensional CT (κ3-dimensional = 0.27, κ2-dimensional = 0.32; p = .015).

Conclusions : Three-dimensional CT reconstructions improve interobserver agreement with respect to fracture classification compared with 2-dimensional CT.

Resolving controversies in hip fracture care : the need for large collaborative trials in hip fractures

Summary: Hip fractures are a significant cause of morbidity and mortality worldwide and the burden of disability associated with hip fractures globally vindicates the need for high-quality research to advance the care of patients with hip fractures. Historically, large, multi-centre randomized controlled trials have been rare in the orthopaedic trauma literature. Similar to other medical specialties, orthopaedic research is currently undergoing a paradigm shift from single centre initiatives to larger collaborative groups. This is evident with the establishment of several collaborative groups in Canada, in the United States, and in Europe, which has proven that multi-centre trials can be extremely successful in orthopaedic trauma research.

Despite ever increasing literature on the topic of his fractures, the optimal treatment of hip ftractures remains unknown and controversial. To resolve this controversy large multi-national collaborative randomized controlled trials are required. In 2005, the International Hip Fracture Research Collaborative was officially established following funding from the Canadian Institute of Health Research International Oppurtunity Program with the mandate of resolving controversies in hip fracture management. This manuscript will describe the need, the information, the organization, and the accomplishments to date of the International Hip Fracture Research Collaborative.

Deformation and fracture characteristics of ferrite/bainite dual-phase steels

The deformation and fracture characteristics of a low carbon Si–Mn steel with ferrite/bainite dual–phase structure were investigated by thermo–mechanical controlled process (TMCP). The results showed that the curves of the instantaneous work–hardening factor n* value versus true strain ε are made up with three stages during uniform plastic deformation: n* value is relatively higher at stage I, decreases slowly with ε in stage II, and then decreases quickly with ε in stage III. Compared tothe equiaxed ferrite/bainite dual–phase steel, the quasi–polygonal ferrite/bainite dual–phase steel shows higher tensile strength and n*value in the low strain region. The voids or micro–cracks formed not only at ferrite–bainite interfaces but also within ferrite grains in the necked region, which can improve the property of resistance to crack propagation by reducing local stress concentration of the crack tips.

Effects of tool positioning on joint interface microstructure and fracture strength of friction stir lap Al-to-steel welds

Friction stir lap welding (FSLW) experiments have been conducted to study the effects of tool positioning on microstructures formed in the Al-to-steel interface region and on joint strength, defined as maximum applied force over the width (F m/w s) of the test sample, of the welds. Various pin positioning and speed conditions were used in the FSLW experiments followed by microstructure examination on the interface regions and tensile-shear testing on the welds, including an examination on crack propagation in mixed stir zone. It was found that when the pin was close to the bottom steel piece, Al-to-steel reaction occurred resulting in intermetallic outbursts formed along the interface. This represents the case of incomplete metallurgical joint. When the pin was lowered to just reach the steel, a thin and continued interface intermetallic layer formed. Evidences and consideration on growth kinetics have suggested that the layer could only remain thin (≤2.5 μm) during FSLW. This layer could bear a high load during tensile-shear testing and the adjacent aluminium deformed and fractured instead. The resulting F m/w s was high. When the pin penetrated to steel, F m/w s reduced due to brittle fracture being dominant inside mixed stir zone. Evidences have shown that the amount of penetration and speed condition during FSLW do not have large effects on F m/w s.

Quantification of sensitization in AA5083-H131 via imaging Ga-embrittled fracture surfaces

Sensitization of 5xxx series Al alloys involving precipitation of β phase (Mg2Al3) at grain boundaries was studied for different exposure times at 100°C upon AA5083-H131 (UNS A95083). In this work, we reveal that fracture surfaces prepared by liquid gallium embrittlement can yield a quantification of grain boundary β phase with significant statistics on β phase size and spacing. This information is a necessary first step toward development of quantitative damage models to describe inter-granular corrosion (IGC) and stress corrosion (IGSCC).

Osteopaenia - a marker of low bone mass and fracture risk

Areal bone mineral density is commonly categorised into normal bone mineral density, osteopaenia and osteoporosis on the basis of nominal thresholds recommended by the World Health Organization. However, bone mineral density is a continuous variable and there is a strong association between lower bone mineral density and greater risk for fracture. Fracture risk is not negligible in persons with moderate deficits in bone mineral density. Although absolute fracture risk is greatest for individuals with osteoporosis, more than half of the fractures arise from those with osteopaenia, and even normal bone mineral density, a probable consequence of greater numbers of individuals at risk in these categories. However, areal bone mineral density measurements used commonly in clinical practice do not detect differences in bone tissue properties, geometry and microarchitecture, which contribute to bone strength. Newer technologies such as high-resolution peripheral computed tomography have the advantage of assessing trabecular and cortical components of bone separately, in addition to geometric characteristics of the skeleton. Quantifying these parameters and considering clinical risk factors that affect fracture risk independent of bone quantity and quality, may better discriminate between high- and low-risk individuals. This would improve the decision-making for targeting appropriate interventions, either lifestyle or medication, to reduce thepublic health burden of fractures.

Personal and psychosocial impacts of clinical fracture in men

Background : Little is known about the personal burden of fracture across the age spectrum, particularly in men. This study aimed to document the impact of clinical fracture on men's participation in employment, sports and outdoor recreation, mobility, handiwork, activities of daily living, home modification, and utilisation of community and health services.

Methods : This prospective study followed 196 men with incident fracture identified from radiology reports at the Geelong Hospital during the period July 2006 to December 2007 and examined personal and psychosocial impacts 12 months post-fracture, using a self-report questionnaire.

Results : Of all men identified with fracture, 40% took time off work. All fractures, except those to the upper limbs, had considerable impact on mobility. Inability to drive was associated with all fractures, but was most common with ankle fractures and most prolonged with hip fractures. Loss of confidence was reported by over one-third of all fracture cases, even 12 months after the fracture event. All fractures affected activities of daily living, and this was generally most prolonged for fractures of the hip. Similarly, all men with fracture utilised community and health services, even for the relatively minor fractures of the finger/thumb.

Conclusions : This study supports previous reports of the personal impact of hip fracture, and presents data about the consequences of upper and lower limb fractures and the generally poorly described sequelae of fractures of the finger/thumb and foot/toe. These observations have important implications for post-fracture care and rehabilitation in men.