Operative Fixation of Pediatric Forearm Fractures: Does the Fracture Location Matter?

Background. Flexible intramedullary nails (FNs) are successfully used to treat pediatric forearm fractures, especially midshaft fractures. Distal forearm fractures have been described as “difficult to manage” with FN insertion. The purpose of this study was to report the clinical and radiographic outcomes of using flexible nails in pediatric forearm fractures and the impact of fracture location on the outcome of the procedure. Methods. This is a retrospective review of pediatric patients who presented with forearm fractures that were surgically treated with flexible nails between 2009 and 2018. Patient demographics, fracture location, and classification were reported. Intraoperative and postoperative complications were reported. The primary outcomes were fracture radiographic union, intraop and postop complications, and the need for additional surgical procedures. Results. Fifty-nine patients were included, with a mean age of 11 years. All fractures healed with patients regaining full range of motion. The authors were able to use flexible nails successfully in 48/59 (81%) patients. In eleven cases (19%), FN fixation was not able to provide adequate fixation to maintain reduction. The method of fixation was changed from FN insertion to another method in nine cases. In two cases, FN fixation was augmented with another fixation method. Fractures within 3 inches of the distal articular surface were at a higher risk of intraoperative change/augmentation of the fixation method (29%) compared with fractures that occurred more than 3 inches from the distal articular surface (11%). Conclusion. The majority of pediatric forearm fractures can be treated successfully with flexible nails. Surgeons involved in treating these fractures should pay attention to distal third fractures. Stabilizing the distally located fractures using FN fixation can be challenging. Surgeons should be prepared to use an alternative fixation method when needed.

Supervised Machine Learning Classification Algorithms for Detection of Fracture Location in Dissimilar Friction Stir Welded Joints

Machine Learning focuses on the study of algorithms that are mathematical or statistical in nature in order to extract the required information pattern from the available data. Supervised Machine Learning algorithms are further sub-divided into two types i.e. regression algorithms and classification algorithms. In the present study, four supervised machine learning-based classification models i.e. Decision Trees algorithm, K- Nearest Neighbors (KNN) algorithm, Support Vector Machines (SVM) algorithm, and Ada Boost algorithm were subjected to the given dataset for the determination of fracture location in dissimilar Friction Stir Welded AA6061-T651 and AA7075-T651 alloy. In the given dataset, rotational speed (RPM), welding speed (mm/min), pin profile, and axial force (kN) were the input parameters while Fracture location is the output parameter. The obtained results showed that the Support Vector Machine (SVM) algorithm classified the fracture location with a good accuracy score of 0.889 in comparison to the other algorithms.

The influence of fracture location and comminution on acute scaphoid fracture displacement: three-dimensional CT analysis

We aimed to assess the influence of fracture location and comminution on acute scaphoid fracture displacement using three-dimensional CT. CT scans of 51 adults with an acute scaphoid fracture were included. Three-dimensional CT was used to assess fracture location, comminution and displacement. Fracture location was expressed as the height of the cortical breach on the volar and dorsal side of the scaphoid relative to total scaphoid length (%), corresponding to the fracture’s entry and exit point, respectively. We found a near-linear relation between dorsal fracture location and displacement. As dorsal fracture location became more distal, translation (ulnar, proximal, volar) and angulation (flexion, pronation) of the distal fragment relative to the proximal fragment increased. Comminuted fractures had more displacement. Dorsal fracture location predictably dictates the direction of translation and angulation in displaced scaphoid fractures. Surgeon attention to dorsal fracture location can help identify displacement patterns and provide guidance in adequately reducing a displaced scaphoid fracture. Level of evidence: III

Management and Long-Term Outcome of Acetabular Fractures in Dogs: A Retrospective Study of 49 Dogs

Objective The aim of this study was to categorize the presentation, management, complications and long-term outcome of canine acetabular fractures, and to determine the factors affecting outcome. Materials and Methods Case records and imaging for dogs with acetabular fractures were reviewed with long-term follow-up via canine brief pain inventory (CBPI) and owner questionnaires. Results The majority of fractures were in the mid-third (36/52) and caudal-third (13/52) with few in the cranial-third of the acetabulum (3/52). Concurrent injuries were diagnosed in 47/49 dogs; 10/34 dogs had neurological deficits on presentation. Forty-seven fractures received treatment: 25/47 had direct surgical repair (DSR), 10/47 had salvage surgery (SS) and 12/47 had conservative management (CM). Fracture location significantly affected treatment group (p = 0.001). New neurological deficits were documented after DSR in 5/24 dogs and SS in 2/10 dogs. Short-term complications occurred after DSR in 10/18 dogs (five minor, five major) and CM in 1/8 dogs (major). Long-term complications occurred after DSR in 2/15 dogs (major) and CM in 2/7 dogs (catastrophic). Conservative management dogs had worse average owner-reported CBPI scores than DSR or SS dogs. Clinical Significance Acetabular fractures predominate in the mid and caudal acetabulum, with high levels of concurrent injuries. Fracture location significantly influenced the treatment approach taken. Postoperative neurological deficits are common following SS and DSR.

The Stability Factors’ Sensitivity Analysis of Key Rock B and Its Engineering Application of Gob-Side Entry Driving in Fully-Mechanized Caving Faces

To reveal the critical factors of the main roof influencing stability of surrounding rocks of roadways driven along goaf in fully-mechanized top-coal caving faces, this paper builds a structural mechanics model for the surrounding rocks based on geological conditions of the 8105 fully-mechanized caving face of Yanjiahe Coal Mine, and the stress and equilibrium conditions of the key rock block B are analyzed, and focus is on analyzing rules of the key rock block B influencing stability of roadways driven along goaf. Then, the orthogonal experiment and the range method are used to confirm the sensitivity influencing factors in numerical simulation, which are the basic main roof height and the fracture location, the length of the key rock block B, and the main roof hardness in turn. It is revealed that the basic main roof height and its fracture location have a greater influence on stability of god-side entry driving. On the one hand, the coal wall and the roof of roadways driven along goaf are damaged, and the deformation of surrounding rocks of roadways and the vertical stress of narrow coal pillars tend to stabilize along with the increase of the basic main roof height. On the other hand, when the gob-side entry is located below the fracture line of the main roof, the damage caused by gob-side entry is the most serious. Therefore, on-site gob-side entry driving should avoid being below the fracture line of the main roof. At last, industrial tests are successfully conducted in the fully-mechanized top-coal caving faces, 8105 and 8215, of Yanjiahe Coal Mine.