Clinico-radiological and functional outcome of surgical management of displaced transverse fracture of patella in adults managed by tension band wiring in a tertiary care hospital in North India: a prospective study

Background: Patella is the largest sesamoid bone in the quadriceps tendon in the body. The main function of patella is to improve the efficiency of quadriceps muscle by improving the mechanical leverage of the quadriceps muscle. There are various methods used for fixation of these fractures. Tension band wiring (TBW) works by converting tensile forces into compressive forces when movements occur at the knee joint. The aim of our study was to evaluate the clinico-radiological and functional outcome of surgical management of displaced transverse fracture of patella in adults managed by TBW.Methods: This was the prospective study of 22 patients aged 20 to 60 years (mean age 41.4 years) with displaced transverse fractures of patella managed by TBW.Results: The final outcome was observed at 6 months follow up. The results were comparable with the existing literature. Radiological union was achieved within 10 to 16.2 weeks, with an average of 12.4 weeks. Out of 22, (n=16, 72.7%) had excellent outcome, (n=5, 22.7%) had good functional outcome, (n=1, 4.5%) had fair outcome. Complications were observed in 6 (27.3%) patients.Conclusions: It is concluded that the surgical treatment with TBW is the best treatment in the management of displaced transverse fractures of patella.

Horizontal Water Injection Wells: Injectivity and Containment of Injection-Induced Fractures

Horizontal water injection wells have the capacity to inject larger volumes of water and have a smaller surface footprint than vertical wells. We present a new quantitative analysis on horizontal well injectivity, injection scheme (matrix vs. fracturing), and fracture containment. To precisely predict injector performance and delineate safe operating conditions, we simulate particle plugging, thermo-poro-elastic stress changes, thermal convection and conduction and fracture growth/containment in reservoirs with multiple layers. Simulation results show that matrix injection in horizontal wells continues over a longer time than vertical injectors as the particle deposition occurs slowly on the larger surface area of horizontal wellbores. At the same time, heat loss occurs uniformly over a longer wellbore length to cause less thermal stress reduction and delay fracture initiation. As a result, the horizontal well length and the injection rates are critical factors that control fracture initiation and long-term injectivity of horizontal injectors. To predict fracture containment accurately, thermal conduction in the caprock and associated thermal stresses are found to be critical factors. We show that ignoring these factors underestimates fracture height growth. Based on our simulation analysis, we suggest strategies to maintain high injectivity and delay fracture initiation by controlling the injection rate, temperature, and water quality. We also provide several methods to design horizontal water injectors to improve fracture containment considering wellbore orientation relative to the local stress orientations. Well placement in the local maximum horizontal stress direction induces longitudinal fractures with better containment and less fracture turning than transverse fractures. When the well is drilled perpendicular to the maximum horizontal stress direction, the initiation of transverse fractures is delayed compared with the longitudinal case. Flow control devices are recommended to segment the flow rate and the wellbore. This helps to ensure uniform water placement and helps to keep the fractures contained.

Clinico-radiological and functional outcome of Mayo type IIA olecranon fractures managed with tension band wiring in a tertiary care centre in North India

<p class="abstract"><strong>Background: </strong>Tension band wiring is the most common operative technique for the internal fixation of olecranon fractures. Stable internal fixation with figure of eight tension band wiring used for simple transverse fractures allows early range of motion, minimize stiffness and gives good results. The aim of this study is to evaluate the functional outcome of simple transverse fractures managed by tension band wiring.</p><p class="abstract"><strong>Methods:</strong> This was an observational prospective study of 24 patients with Mayo type IIA fractures aged between 18 to 65 years, with mean age of 42.5 years treated by tension band wiring. Functional outcome was assessed with Mayo Elbow Performance Score (MEPS) and Visual Analogue Scale (VAS) subjective pain score.</p><p class="abstract"><strong>Results: </strong>Our study was conducted on 24 patients with Mayo type IIA, out of which 16 were males and 8 were females. Most common mode of injury was fall from standing height (75%), followed by road traffic accident (16.7%) and assault (8.3%). The age range was between 18 to 65 years, with mean age of 42.5 years.</p><p class="abstract"><strong>Conclusions:</strong> Tension band wiring is an effective method for the treatment of transverse, non-comminuted and unstable fractures of the olecranon which provides stable fixation, early rehabilitation and gives excellent results when done in expert hands.</p>

The Clinical Efficacy of Anterior Pelvic Wall Locking Plate Fixation Through the Lateral Rectus Approach for Treating Quadrilateral Surface Acetabular Fractures

Background:Cases of acetabular fractures involving the quadrilateral surface are increasing annually. Quadrilateral surface surgery is complex, involves combined approaches, and the quality of fracture reduction closely depends on the surgical procedure. This study aimed to explore the clinical effects of the anterior pelvic wall locking plate through the lateral rectus approach for treating acetabular fractures involving quadrilateral surface. Methods:A retrospective analysis of 35 patients with acetabular fractures involving the quadrilateral surface treated with anterior pelvic wall-locking plates at the First Affiliated Hospital of Soochow University from June 2016 to December 2020. Patients included 25 males and ten females; age 23-82 years, average 52.4 years. The fracture classification was based on the Letournel-Judet classification: 13 cases of double-column fractures, seven cases of T-shaped fractures, seven cases of anterior wall with posterior semi-transverse fractures, and eight cases of transverse fractures. All patients were exposed through the lateral rectus approach, and fractures were fixed with the anterior pelvic wall-locking plate combined with the reconstruction plate. The Matta imaging standard assessed the quality of fracture reduction, and hip joint function was assessed according to the modified Merled’Aubigné-Postel scoring standard. Results:Patients meeting the inclusion and exclusion criteria were followed up for 12-42 months, with an average of 26.1 months. At the last follow-up, Matta imaging evaluation showed that 24 cases were anatomically reduced (68.6%, 24/35), seven cases were satisfied (20%, 7/35), and four cases were dissatisfied (11.4%, 4/35). The satisfaction rate was 88.6% (31/35), according to the modified Merled'Aubigné-Postel scoring standard. The hip function was excellent in 23 cases, good in six cases, fair in four cases, and poor in two cases. The excellent and good rates were 82.9% (29/35). Conclusion: The acetabular fracture involving the quadrilateral surface is clearly revealed through the lateral rectus approach. The anterior pelvic wall-locking plate combined with the reconstruction plate can fix well, with satisfactory clinical effects.

Novel Completion Designs in Horizontal Well with Transverse Hydraulic Fractures for Enhanced Recovery in Unconventional or Tight Reservoirs

Low recovery, 2 to 15%, in unconventional plays (including tight reservoirs and source rocks) has long been recognized as a business deterrent. The industry applies enhanced oil recovery (EOR) techniques, along with hydraulic fractures in tight/unconventional plays, to improve the recovery. To maximize matrix sweep, the fractures are aligned in a face-to-face assembly. Such an arrangement can be achieved using vertical or longitudinal hydraulic fracture on horizontal wells, but these, generally, do not provide as effective reservoir contact (hydraulic fracture surface area) as horizontal wells with multistage transverse hydraulic fractures. The multistage transverse hydraulic fracture, however, comes at the costs of conformance issues with early water breakthrough from short-circuiting and inability to achieve fracture face-to-fracture face alignment of the injection and production fractures. The vast majority of wells drilled in unconventional plays are in the transverse configuration; hence, there is a need for an optimal solution for transverse fractures combined with improved oil recovery (IOR)/EOR approaches. In this work, we introduce the multistage enhanced recovery (MS-ER) techniques that enable face-to-face alignment for optimal enhanced hydrocarbon recovery/IOR/EOR in horizontal wells with multistage transverse fractures, thereby enabling optimal recovery and mitigating the key risk of fracture short-circuiting.

Axial Fracture Initiation During Diagnostic Fracture Injection Tests and Its Consequences on Interpretations

Diagnostic fracture injection tests (DFIT) are used widely in the unconventional reservoirs to obtain formation properties. These properties can be crucial in optimizing primary and infill completions. The interpretation methods are assuming that pumping fluid would create a single planar fracture, however, perforation frictions and near wellbore stress concentration may accommodate initiation of fractures along the casing first (axial fractures). The possibility of the formation of an axial fracture increases in high injection rates and low differential stresses. In this study, we investigate the effect of the formation of an additional axial fracture on a DFIT test and its interpretation, using a fully coupled geomechanics and fluid flow model. We provide a model for the initiation and closure of axial and transverse fractures during the process. We also demonstrate that the estimate of the closure stress can be misleading when presence of an additional axial fracture is ignored. Finally, we discuss a potential method to determine the maximum horizontal stress under such circumstances. In fact, the variations in cement quality, cement type and its placement play roles in linking of adjacent perforations and form axial fractures, therefore it might be difficult to establish a safe perforation design to avoid initiation of axial fractures, but we can adjust our analysis to incorporate axial fractures effect.

Rehabilitation of a green sea turtle (Chelonia mydas) after collision with motorboat in the archipelago of Fernando de Noronha, Brazil

A juvenile green sea turtle (Chelonia mydas) of undetermined sex was rescued on October 16, 2019, in the archipelago of Fernando de Noronha, Pernambuco, Brazil. The animal was presence of active bleeding resulting from two transverse fractures in the carapace, with exposure of the coelomic cavity. Radiological and hematological tests were performed. The animal received therapeutic support and surgical reconstruction of the carapace. The animal was medically cleared and reintroduced into the natural environment 120 days after it was rescued. The protocol used here for both the rehabilitation and the surgical procedure was concluded to be effective.

Anterograde fixation of inverted oblique medial malleolus fractures

Fractures of the medial malleolus are common, with avulsion being the main trauma mechanism. In simple transverse fractures, retrograde fixation with interfragmentary screws is the most common means of achieving anatomical reduction and absolute stability. However, greater attention must be paid in cases of inverted oblique fractures, which make traditional fixation difficult. We report a case in which anatomical reduction and stabilization were achieved using a reduction clamp and two headless compression screws placed anteriorly, resulting in a mechanically stable, safe and effective repair. Level of Evidence V, Therapeutic Studies; Expert Opinion.

Surgical outcomes of transverse acetabular fractures and risk factors for poor outcomes

Background Transverse acetabular fractures, although classified as elementary, have worse outcomes than other types of acetabular fractures. Prognostic factors for this fracture type are not clearly established. This study aimed to assess the surgical outcomes of transverse acetabular fractures and subtypes thereof and to investigate the prognostic factors. Methods Between 2014 and 2019, 39 patients (39 hips) had transverse fractures or subtypes thereof. We reviewed the surgical outcomes and evaluated patient factors, injury factors, and surgical factors in relation to osteoarthritis (OA) and conversion to total hip arthroplasty (THA). Additionally, we analyzed the cutoff values for postoperative residual gaps and steps. Results Twenty-three male patients and sixteen female with a mean age of 41.7 years (range, 18–78 years) were included. There were 29 satisfactory reductions (74.4%). Eleven hips (28.2%) developed OA, and five (12.8%) of them underwent THA. Dome impaction (odds ratio [OR], 41.173; 95% confidence interval [CI], 1.804–939.814; p = 0.020) and residual gaps (OR, 4.251; 95% CI, 1.248–14.479; p = 0.021) were correlated with poor outcomes. Residual gaps (≥3 mm) and residual steps (≥1 mm) were significantly associated with OA. Conclusions Relatively poor reduction was found for transverse acetabular fractures and subtypes thereof. However, the rates of OA and conversion to THA were not high. Dome impaction and wide residual gaps were identified as risk factors for poor outcomes. The development of OA significantly increased if residual gap and step were more than 3 mm and 1 mm, respectively.