Journal articles: 'Fractures, Open'

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Blease, Robert, and Enes M. Kanlić. "Management of Open Fractures." Bosnian Journal of Basic Medical Sciences 5, no. 4 (November 20, 2005): 14–21. http://dx.doi.org/10.17305/bjbms.2005.3224.

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The large spectrum of open fractures is an amalgamation of injuries with the single variable in common of communication of the fractured bone with the outside environment, and thus an increased risk for infection. Contributing to the presence of bacteria within the fracture site is devascularized soft tissue, the degree of which can be directly attributed to the amount of energy imparted to the tissues. The currently used classification system aids in defining the degree of severity of these injuries and their subsequent risk for infection. The basic management principal for all of these injury patterns remains essentially the same, however: prevention of infection through debridement, wound management, antibiotic usage, and fracture stabilization. Frequently multiple surgical procedures will be required in order to obtain an infection free, united fracture with adequate soft tissue coverage (1).

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Wennberg, O. P., G. McQueen, P. H. Vieira de Luca, F. Lapponi, D. Hunt, A. S. Chandler, A. Waldum, G. Nery Camargo, E. Castro, and L. Loures. "Open fractures in pre-salt silicified carbonate reservoirs in block BM-C-33, the Outer Campos Basin, offshore Brazil." Petroleum Geoscience 27, no. 4 (March 18, 2021): petgeo2020–125. http://dx.doi.org/10.1144/petgeo2020-125.

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Natural open fractures are present in sidewall cores and in whole-core samples from pre-salt reservoirs in the licence block BM-C-33 in the Campos Basin, Brazil. Open fractures are also observed in borehole image logs, and fracture densities are in general high. The highest density of open fractures is seen in the damage zones above and below larger cavities (amalgamated cavern damage zones (ACDZs)). Outside the ACDZs the fracture density is high in silicified carbonates, where it tends to increase with decreasing porosity. Clean dolomites are less fractured than the silicified interval, while the less brittle argillaceous dolomites have the lowest fracture density. Some fractures appear vuggy on borehole image logs, and fracture densities are high close to vugs and larger cavities. The positive correlation between fractures and vugs is caused by flow of dissolving fluids through open fractures, and fracturing at stress concentrations around vugs. Two major fault zones have been interpreted from borehole image logs that have damage zones with very high fracture density. The well-test permeability is much greater than the matrix permeability estimated from sidewall core and log measurements. This excess permeability is attributed to fractures, in combination with caverns and intervals with frequent vugs.

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Hadfield, James N., Tomisin S. Omogbehin, Charlotte Brookes, Reece Walker, Alex Trompeter, Christopher P. Bretherton, Andrew Gray, and William G. P. Eardley. "The Open-Fracture Patient Evaluation Nationwide (OPEN) study." Bone & Joint Open 3, no. 10 (October 1, 2022): 746–52. http://dx.doi.org/10.1302/2633-1462.310.bjo-2022-0079.r1.

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Aims Understanding of open fracture management is skewed due to reliance on small-number lower limb, specialist unit reports and large, unfocused registry data collections. To address this, we carried out the Open Fracture Patient Evaluation Nationwide (OPEN) study, and report the demographic details and the initial steps of care for patients admitted with open fractures in the UK. Methods Any patient admitted to hospital with an open fracture between 1 June 2021 and 30 September 2021 was included, excluding phalanges and isolated hand injuries. Institutional information governance approval was obtained at the lead site and all data entered using Research Electronic Data Capture. Demographic details, injury, fracture classification, and patient dispersal were detailed. Results In total, 1,175 patients (median age 47 years (interquartile range (IQR) 29 to 65), 61.0% male (n = 717)) were admitted across 51 sites. A total of 546 patients (47.1%) were employed, 5.4% (n = 63) were diabetic, and 28.8% (n = 335) were smokers. In total, 29.0% of patients (n = 341) had more than one injury and 4.8% (n = 56) had two or more open fractures, while 51.3% of fractures (n = 637) occurred in the lower leg. Fractures sustained in vehicle incidents and collisions are common (38.8%; n = 455) and typically seen in younger patients. A simple fall (35.0%; n = 410) is common in older people. Overall, 69.8% (n = 786) of patients were admitted directly to an orthoplastic centre, 23.0% (n = 259) were transferred to an orthoplastic centre after initial management elsewhere, and 7.2% were managed outwith specialist units (n = 81). Conclusion This study describes the epidemiology of open fractures in the UK. For a decade, orthopaedic surgeons have been practicing in a guideline-driven, network system without understanding the patient features, injury characteristics, or dispersal processes of the wider population. This work will inform care pathways as the UK looks to the future of trauma networks and guidelines, and how to optimize care for patients with open fractures. Cite this article: Bone Jt Open 2022;3(10):746–752.

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Golubovic, Zoran, Predrag Stojiljkovic, Lana Macukanovic-Golubovic, Dragan Milic, Sasa Milenkovic, Marko Kadija, Zoran Matovic, et al. "External fixation in the treatment of open tibial shaft fractures." Vojnosanitetski pregled 65, no. 5 (2008): 343–48. http://dx.doi.org/10.2298/vsp0805343g.

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Background/Aim. Besides the conquasant fractures, open tibia shaft fractures belong to the group of the most severe fractures of tibia. Open tibia shaft fracture is one of the most common open fractures of long bones. They most frequently occur as a result of traffic accidents caused by the influence of a strong direct force. Methods. Within the period from January, 2000 to December 31, 2005. at the Clinic for Orthopaedics and Traumatology, Clinical Center Nis, 107 patients with open tibial fractures were treated. We analyzed 96 patients with open tibial fracture. In the series analyzed, the male sex was prevalent - there were 74 men (77.08%). The mean age was 47.3 years. The youngest patient was 17 years old, while the oldest patient was 79. According to the classification of the Gustilo et al. in the analysed group there were 30 (31.25%) open tibial fractures of the I degree, 31 (32.29%) of the II degree, 25 (26.05%) of the III A degree, 8 (8.33%) of the III B degree and 2 (2.08%) of the III C degree. In 95 of the patients the treatment of open tibia shaft fractures consisted of the surgical treatment of wound and the external fixation of the fractured bone using "Mitkovic" type external fixator with a convergent method of pin applications. One primary amputations had been done in patients with grade IIIC open tibial fracture with large soft tissue defect. Results. Of the 96 open tibial fractures available for follow-up, 73 (76.04%) healed without severe complications (osteitis, pseudoarthrosis, valgus malunion and amputation). Ther were nine (9.38%) soft tissue pin track infections and six (6.25%) superficial wound infections. The mean time of union was 21 (14-36) week. Among severe local complications associated with open tibial fractures, in eight patients (8.33%) was registered osteitis, and in nine patients (9.38%) fracture nonunion and the development of pseudoarthrosis. Three of the patients (3.13%) had more than 10 degree valgus malunion. In one patients (1.04%) deep pin track infection developed. Two patients (2.08%) had below the knee amputation (one primary in patient with type III C open fracture and one secondary after the development of deep infections). Conclusion. Surgical treatment of wounds, external fixation, leaving the wounds open and performing necessary debridements, adequate drug therapy administration are essential for obtaining good results in patients with open tibial shaft fractures.

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Gray, Sarah N., Mathieu Spriet, Tanya C. Garcia, Francisco A. Uzal, and Susan M. Stover. "Preexisting lesions associated with complete diaphyseal fractures of the third metacarpal bone in 12 Thoroughbred racehorses." Journal of Veterinary Diagnostic Investigation 29, no. 4 (April 19, 2017): 437–41. http://dx.doi.org/10.1177/1040638717704866.

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We characterized features of complete diaphyseal fractures of third metacarpal bones in Thoroughbred racehorses. Given that stress fractures are known to occur in the third metacarpal bone, an additional aim was to determine if complete fractures are associated with signs of a preexisting incomplete stress fracture. Bilateral metacarpi from 12 Thoroughbred racehorses euthanized because of complete unilateral metacarpal diaphyseal fracture were examined visually and radiographically. Open, comminuted, transverse or short oblique fractures occurred in the middle of the diaphysis or supracondylar region. Periosteal surface discoloration and bone callus formation contiguous with the fracture line were present in fractured bones. All contralateral intact metacarpi had gross anatomic lesions, and 10 had radiographic abnormalities similar to those observed on fractured metacarpi. Catastrophic metacarpal fractures occurred in racehorses with bilateral evidence of preexisting bone injury.

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Babhulkar, Sudhir, and HKT Raza. "Open fractures." Indian Journal of Orthopaedics 42, no. 4 (2008): 365. http://dx.doi.org/10.4103/0019-5413.43370.

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Muñoz Vives, J. M., P. Caba Doussoux, and D. Martí i Garín. "Open fractures." Revista Española de Cirugía Ortopédica y Traumatología (English Edition) 54, no. 6 (January 2010): 399–410. http://dx.doi.org/10.1016/s1988-8856(10)70270-4.

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Mohiuddin, M., M. Hasan, M. Shohag, R. N. Ferdousy, M. M. Alam, and N. S. Juyena. "Surgical management of limb fractures in calves and goats." Bangladesh Veterinary Journal 52, no. 1-4 (December 25, 2018): 46–56. http://dx.doi.org/10.32856/bvj-2018.06.

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The study was conducted to determine the occurrence of fractures in calves and goats at Veterinary Teaching Hospital (VTH), Bangladesh Agricultural University (BAU) and to compare the efficacy of fracture treatment with external and internal fixation using splints and bone plate/wire suture respectively. Patients brought to VTH with the history of automobile accident, trauma and clinical signs suggestive of fractures were subjected to detailed physical, orthopaedic and radiographic examinations to confirm fractures. A total of 6 calves and 4 Black Bengal goats were presented to VTH with limb fractures. Fractures were treated with close reduction and external fixation with splints and bandage, and open reduction and internal fixation with wire suture and bone plate. 50% and 75% fracture cases healed properly in calves and goats respectively. Among the affected animals, 60% were females irrespective of species. Metacarpal bone was the most susceptible for limb fracture. Three were open fractures and 7 cases were closed fracture with the occurrence of 70%. The healing percentage of open fracture treated with external fixation was very poor and amputation was needed in the fractured limb. Overall treatment success rate was 60 %. Biochemical analysis revealed very significant (p<0.01) difference in serum calcium level before and after healing due to hard callus formation. This study shows that bone plating fixation give a satisfactory results to calves with fracture. Moreover, the study could help veterinarians to set up proper treatment method depending on location of fracture.

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C. Hiremath, Mallayya, SK Srinath, Aarcha S. Kumar, and Pushpalatha Shivashankar. "Management of minimally displaced mandibular fracture with customized open cap splint in an 11-year child: A case report." Contemporary Pediatric Dentistry 3, no. 2 (September 30, 2022): 80–85. http://dx.doi.org/10.51463/cpd.2022.103.

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Mandibular fractures are the most common type of facial skeletal injury in children. In descending order, the most common is the condylar region then angle, and thirdly body fractures. Most of the fractures are greenstick type in children, because of the presence of permanent tooth buds which hold the fractured mandibular fragments like glue. Hence, conservative management is preferred and the fractures heal well and rapidly in children. The condylar neck in children being short and thick helps to resist the fracture, making most of them the nondisplaced type of fractures. The purpose of this case report is to present a conservative and effective treatment technique for pediatric mandibular fractures using a customized acrylic cap splint. This method has many advantages like simplicity of design, ease of fabrication, and reliability. This method takes care of anatomical, physiological, and psychological aspects as well as the complexity of developing jaws in children. Keywords: Children; Closed Fracture Reduction; Mandibular Fracture; Splint

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Golubovic, Ivan, Branko Ristic, Predrag Stojiljkovic, Milan Ciric, Ivana Golubovic, Zoran Radovanovic, Sladjana Petrovic, Nina Djordjevic, Zoran Golubovic, and Stevo Najman. "Results of open tibial fracture treatment using external fixation." Srpski arhiv za celokupno lekarstvo 144, no. 5-6 (2016): 293–99. http://dx.doi.org/10.2298/sarh1606293g.

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Introduction. Open lower leg fractures are the most common open fractures of the locomotor system and their treatment is associated with a number of complications. Objective. The aim of the paper was to present the results of the treatment of 68 patients with open lower leg fractures, as well as the complications that accompany the treatment of these fractures. Methods. In the analyzed group, there were 45 (66.18%) men and 23 (33.82%) women. The majority of patients - 33 (48.53%) of them - were injured in motor vehicle accidents, whereas 24 (35.29%) patients sustained injuries due to falls from heights. In two (2.94%) patients the cause of open tibial fractures was gunshot injuries. In the analyzed group, there were 18 (26.47%) type I open fractures, 21 (30.88%) type II open fractures, 19 (27.94%) type IIIA open fractures, seven (10.29%) type IIIB open fractures, and three (4.41%) type IIIC open fractures. Results. The tibial shaft fracture healed without serious complications in 50 (73.53%) patients, whereas in 18 (26.47%) patients we observed some complications. Nonunion was found in 10 (14.71%) patients, osteitis in four (5.88), malunion in two (2.94%) patients. Milder complications such as soft tissue pin tract infection developed in 13 (19.12%) patients, infection of the open fracture wound soft tissue was observed in four (5.88%) patients. Conclusion. Basic principles in the treatment of open lower leg fractures in this study are thorough primary open fracture wound treatment followed by the delayed wound closure, stable fracture fixation using unilateral external skeletal device, proper antibiotic treatment and tetanus prophylaxis. The results correlate with similar studies.

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Kim, Young-Woo, Ho-Youn Park, and Yoo-Joon Sur. "Soft Tissue Reconstruction for Open Tibia Fractures." Archives of Hand and Microsurgery 25, no. 3 (September 1, 2020): 207–18. http://dx.doi.org/10.12790/ahm.20.0037.

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Tibia fractures are the most common long bone fracture and about 24% of them are open fractures. Open fractures accompany disruption of the soft tissue around the fracture site and the fractures are exposed to the external environment. Contamination of the fracture site and devitalization of the injured soft tissue greatly increase the risk of infection, nonunion, and other complications. The first and most important treatment goal of open fractures is prevention of infection. To accomplish this objective, immediate radical debridement and irrigation, second-look operation, and subsequent soft tissue reconstruction should be performed as soon as possible. However, early soft tissue reconstruction is not always possible and when it should be delayed, negative pressure wound therapy is recommended. Among various reconstructive armamentarium including skin graft, local flaps, pedicled flaps, and free flaps, the best method need to be chosen based on patient’s general condition, size of defect, neurovascular status, range of injury zone, and cosmetic and functional perspectives. Preoperative in-depth evaluation of vascular structures is mandatory and free flaps are preferred when the range of injury zone is wide.

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Winstanley, Robert J. H., James N. Hadfield, Reece Walker, Christopher P. Bretherton, Neil Ashwood, Keith Allison, Alex Trompeter, and William G. P. Eardley. "The Open-Fracture Patient Evaluation Nationwide (OPEN) study." Bone & Joint Journal 104-B, no. 9 (September 1, 2022): 1073–80. http://dx.doi.org/10.1302/0301-620x.104b9.bjj-2022-0202.r1.

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Aims The Open-Fracture Patient Evaluation Nationwide (OPEN) study was performed to provide clarity in open fracture management previously skewed by small, specialist centre studies and large, unfocused registry investigations. We report the current management metrics of open fractures across the UK. Method Patients admitted to hospital with an open fracture (excluding phalanges or isolated hand injuries) between 1 June 2021 and 30 September 2021 were included. Institutional information governance approval was obtained at the lead site and all data entered using Research Electronic Data Capture software. All domains of the British Orthopaedic Association Standard for Open Fracture Management were recorded. Results Across 51 centres, 1,175 patients were analyzed. Antibiotics were given to 754 (69.0%) in the emergency department, 240 (22.0%) pre-hospital, and 99 (9.1%) as inpatients. Wounds were photographed in 848 (72.7%) cases. Median time to first surgery was 16 hrs 14 mins (interquartile range (IQR) 8 hrs 29 mins to 23 hrs 19 mins). Complex injuries were operated on sooner (median 12 hrs 51 mins (IQR 4 hrs 36 mins to 21 hrs 14 mins)). Of initial procedures, 1,053 (90.3%) occurred between 8am and 8pm. A consultant orthopaedic surgeon was present at 1,039 (89.2%) first procedures. In orthoplastic centres, a consultant plastic surgeon was present at 465 (45.1%) first procedures. Overall, 706 (60.8%) patients required a single operation. At primary debridement, 798 (65.0%) fractures were definitively fixed, while 734 (59.8%) fractures had fixation and coverage in one operation through direct closure or soft-tissue coverage. Negative pressure wound therapy was used in 235 (67.7%) staged procedures. Following wound closure or soft-tissue cover, 509 (47.0%) patients received antibiotics for a median of three days (IQR 1 to 7). Conclusion OPEN provides an insight into care across the UK and different levels of hospital for open fractures. Patients are predominantly operated on promptly, in working hours, and at specialist centres. Areas for improvement include combined patient review and follow-up, scheduled operating, earlier definitive soft-tissue cover, and more robust antibiotic husbandry. Cite this article: Bone Joint J 2022;104-B(9):1073–1080.

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Mohan, Muralee, Tripthi P. S., Pratiksha Shetty, and Akash Menon. "Keen's Approach: A Dynamic Approach for Zygomatic Arch Fracture Management." Journal of Health and Allied Sciences NU 06, no. 04 (December 2016): 92–94. http://dx.doi.org/10.1055/s-0040-1708684.

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AbstractMaxillofacial fractures are often associated with blunt head injuries of which the outward projection of the Zygomatic Arch exposes it to frequent injury. Isolated Zygomatic arch fractures account for 10% of all Zygomatic bone fractures. Depressed Zygomatic arch fractures causes restricted mouth opening due to the partial or total obstruction of the movement of mandibular coronoid and condylar processes. Numerous techniques have been used to approach the site and reduce the fractured fragments, such as the Gillie's temporal approach, Keen's intraoral approach, anterior cheek skin incision and direct open approach.Below is a case report of an isolated Zygomatic arch fracture following a road accident in a middle aged woman that was surgically treated by open reduction through the Keen's intraoral approach. Successful reduction of the fractured segments and restoration of function was achieved with no scarring, minimal post-operative pain and satisfactory aesthetics.

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Majumdar, Aditi S., and Andrea Bauer. "The Open Approach to a Supracondylar Humerus Fracture." Journal of the Pediatric Orthopaedic Society of North America 4, no. 1 (January 29, 2022): 1–13. http://dx.doi.org/10.55275/jposna-2022-0020.

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The open approach to a supracondylar humerus fracture may be needed for open fractures, vascular compromise, and most commonly, irreducible fractures refractory to closed management. Gartland types III and IV fractures as well as flexion-type fractures are more likely to require an open technique. Vascular compromise can be overt as is the case of a white, pulseless extremity or more subtle as with the “pink, pulseless” extremity. The use of Doppler signals intraoperatively can be helpful to distinguish which “pink, pulseless” cases warrant open exploration. Intraoperative signs of irreducibility include persistent gapping at the fracture site, loss of Baumann’s angle, and discontinuous columns on oblique views. In the scenario an open technique may be necessary, our recommended setup involves positioning of the patient supine on an operating table with a radiolucent hand table attached. An anterior approach to the antecubital fossa is both cosmetic and extensile. This is our preferred approach for rreducible extension-type fractures, suspected interposition brachialis muscle and fascia, median nerve sensory deficits, and vascular exploration. The medial approach is best for flexion-type fractures, ulnar nerve entrapment, extension-type fractures with posterolateral displacement, and oblique or unstable fractures necessitating medial pinning. Postoperative treatment is similar after open technique as for closed pinning of a supracondylar humerus fracture.

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Sebaaly, Amer, Maroun Rizkallah, Guillaume Riouallon, Zhi Wang, Pierre Emmanuel Moreau, Falah Bachour, and Ghassan Maalouf. "Percutaneous fixation of thoracolumbar vertebral fractures." EFORT Open Reviews 3, no. 11 (November 2018): 604–13. http://dx.doi.org/10.1302/2058-5241.3.170026.

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Surgical treatment of patients with thoracolumbar vertebral fracture without neurological deficit is still controversial. Management of vertebral fracture with percutaneous fixation was first reported in 2004. Advantages of percutaneous fixation are: less tissue dissection; decreased post-operative pain; decreased bleeding and operative time (depending on the steep learning curve); better screw positioning with fluoroscopy compared with an open freehand technique; and a decreased infection rate. The limitations of percutaneous fixation of vertebral fractures include increased radiation exposure to the patient and the surgeon, together with the steep learning curve for this technique. Adding a screw at the level of the fractured vertebra has the advantages of incorporating fewer motion segments with less operative time and bleeding. This also increases the axial, sagittal and torsional stiffness of the construct. Percutaneous fixation alone without grafting is sufficient for treating type A and B1 (AO classification) thoracolumbar fractures with satisfactory results concerning kyphosis reduction when compared with open instrumentation and fusion and with open fixation. Type C and B2 fractures (ligamentous injuries) should undergo fusion since the ligamentous healing is mechanically weak, increasing the risk of instability. This review offers a detailed description of percutaneous screw insertion and discusses the advantages and disadvantages. Cite this article: EFORT Open Rev 2018;3:604-613. DOI: 10.1302/2058-5241.3.170026.

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Sun, X. "NATURAL FRACTURES OF THE SOUTHERN COOPER AND EASTERN WARBURTON BASINS, SOUTH AUSTRALIA." APPEA Journal 41, no. 1 (2001): 201. http://dx.doi.org/10.1071/aj00010.

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A study of the southern Cooper and eastern Warburton Basins has resulted in classifying natural fractures and delineating regional fracture systems and orientations of open and partially open fractures. Firstly, natural fractures have been identified from selected lithological units in 44 wells of the southern Cooper Basin. Open fractures are developed mainly within the brittle Tirrawarra Sandstone. These open fractures are mostly high angle to subvertical, with measured apertures of up to 2 mm. Secondly, natural fractures have been characterised in Warburton Basin cores from 91 wells, 27 of which have dipmeter and/or FMS (Formation Micro- Scanner) logs. Fractures more commonly occur within brittle sandstone, dolomite, grainy limestone and ignimbrite.Two systems of orthogonal, high-angle, regional fracture sets (four fractures) have been identified. They extend across local structures in both basins in South Australia. System I is comprised of a pair of orthogonal fractures, striking NNE–SSW (20–200°) and ESE–WNW (110–290°), while a second pair of orthogonal fracture sets, striking NE–SW (60–240°) and NW–SE (150–330°), characterises System II. Open, steeply dipping SW fractures striking WNW and NW within Systems I and II have been interpreted from core and FMS data in several wells. The results indicate that an optimum well trajectory designed to maximise intersection with open natural fractures should be 200–210° and 240–250°, and possibly also 270–290°. The deviation angle should be 30° from horizontal in the fracture zone due to the high-angle and subvertical fracture dips. A semi-quantitative estimate of fracture density from cores in both basins has been determined: the greatest fracture density is located within major fault zones and structural culminations.

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Kulkarni, Shrihari L., Sunil Mannual, Manjunath Daragad, Naveenkumar Patil, and Deekshith Shetty. "Management of Patella Fractures Non-amenable to Tension Band Wiring: Series of Nine Cases with Review of Literature." Journal of Orthopaedic Case Reports 12, no. 3 (2022): 38–42. http://dx.doi.org/10.13107/jocr.2022.v12.i03.2708.

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Introduction: Patella fractures account for about 1% of all musculoskeletal injuries. Modified tension band wiring (TBW) is the most commonly used technique for the management of patella fractures. However, all patella fractures are not-amenable to TBW. In this series, we present nine cases managed with open reduction and internal fixation using non-absorbable braided polyester suture (Ethicon Ethibond Excel 5-0) with circumferential stainless-steel wiring. Case Series: This series included nine patients with fractured patella and managed with open reduction and internal fixation with non-absorbable sutures and circumferential wiring. Patient demographics, fracture type, time to union, functional outcome, and complications were recorded. Patients were followed up for minimum of 6 months (11.6 ± 3.7 months). All fractures went on to unite with average fracture healing time of 13.8 weeks. Mean Lyshom and Bostman score were 83 and 25.6, respectively. Seven patients had excellent to good outcome. One each had fair and poor outcomes. One patient developed superficial infection and knee stiffness. Conclusion: Open reduction and fixation with non-absorbable sutures augmented with circumferential wiring are an efficient method for the management of severely comminuted and multi-fragmentary lower pole patella fractures with minimum complications.

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Walker, R., S. Middleton, and S. A. Stapley. "The principles of managing open fractures." Journal of The Royal Naval Medical Service 100, no. 1 (March 2014): 20.1–25. http://dx.doi.org/10.1136/jrnms-100-20.

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AbstractAny fracture of a bone which communicates with the outside environment via a wound in the skin is classified as an open fracture. This may be from penetration by sharp objects from the exterior, laceration caused by the fracture fragments, or shearing forces that tear or de-glove soft tissue from a limb. These injuries vary in mechanism and severity, ranging from a broken finger caught in a bulkhead door to a catastrophic lower limb fracture suffered from an improvised explosive device (IED). We address the management principles that can be applied to all open fractures regardless of cause.

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Nagi, Ahmed, Islam Mubark, Islam Sarhan, and Abdelaleem Ragab. "Management of Unstable Phalangeal Shaft Fractures Using External Minifixator." Ortopedia Traumatologia Rehabilitacja 21, no. 3 (June 30, 2019): 177–86. http://dx.doi.org/10.5604/01.3001.0013.2922.

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Background. Fractures of the hand are the most common fractures in the skeletal system and phalangeal fractures constitute about 46% of all hand fractures. Operative treatment of unstable phalangeal fractures should aim at anatomic fracture reduction and stable fixation that allows early mobilization of the affected finger’s joints . This study evaluates the results of fixation of unstable shaft fractures of finger proximal or middle phalanges using a non-spanning external minifixator. Material and methods. 32 men and 8 women aged 17 to 60 (median, 31.25) years suffering from fractures of 44 phalanges in 40 hands were included in the study. Four of the fractured phalanges were middle phalanges and 40 were proximal phalanges .All fractures were fixed using a mini external fixator. All procedures were done under regional anaesthetic block. The fixator was applied after closed reduction of fractures. Additional procedures included wound debridement in open fractures, and tendon repair was needed in 4 cases. We excluded fractures where intraarticular fracture extension mandates open reduction and internal fixation. Results. At the end of the follow-up period (mean follow-up 11.5 months), patients were assessed clinically and radiologically. 26 fingers (59.1 %) had “excellent” results , 14 fingers (31.8 %) had “good” results and 4 fingers (9.1%) had “poor” results as their P.I.P. flexion ranges were < 80˚. Conclusion. External fixation of displaced phalangeal shaft fractures is an effective method of treatment in terms of a minimally invasive technique with rigid fracture fixation allowing early mobilization after surgery.

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Al-Busaidi, Rashid. "The Use of Borehole Imaging Logs to Optimize Horizontal Well Completions in Fractured Water-flooded Carbonate Reservoirs." GeoArabia 2, no. 1 (January 1, 1997): 19–34. http://dx.doi.org/10.2113/geoarabia020119.

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ABSTRACT Early water breakthrough has occurred in the Lower Cretaceous carbonate reservoirs (Aptian Shu’aiba Formation) in Yibal and Lekhwair fields, north Oman. Borehole Image logs were run in more than 10 horizontal wells in each field to investigate the role of faults and fracture systems, as well as facies variations and sedimentary features. These logs indicated the presence of highly-fractured zones with both open and cemented fractures. The fractures have orientations consistent with fault patterns interpreted from 3-D seismic data. High density fractured zones, in most cases, correspond to faults, some of which are below seismic resolution. The presence of fractures and/or fracture zones is the primary cause of early water breakthrough. Improved production performance was achieved by perforating non-fractured intervals to avoid early high water cuts.

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Reasoner, Kaitlyn, Mihir J. Desai, and Donald H. Lee. "Factors Influencing Infection Rates after Open Hand Fractures." Journal of Hand and Microsurgery 12, no. 01 (November 22, 2019): 56–61. http://dx.doi.org/10.1055/s-0039-3399488.

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Abstract Introduction Open hand fractures are anecdotally reported to have lower infection rates than open long bone fractures. Although a 3-hour rule for antibiotic administration and a 6-hour rule for operative debridement have historically been upheld as ideal management for open fractures, other factors may be more influential in the development of infection. The purpose of this study was to investigate factors associated with open hand fracture infections. Materials and Methods We retrospectively reviewed 67 patients with 107 open hand fractures between 2012 and 2017. Time from injury to antibiotic administration and operative debridement, modified Gustilo–Anderson classification, and patient characteristics including age, smoking status, and presence of chronic disease were examined for each patient. Outcome parameters were the development of infection and fracture union. Results The overall rate of infection was 9% (6 of 67 patients). No type 1 or type 2 fractures developed infection in contrast to 12.2% of type 3 fractures. Patients who received antibiotics in less than 3 hours and underwent debridement in less than 6 hours did not have lower infection or nonunion rates than those who did not. The association between the modified Gustilo–Anderson classification and the development of infection or nonunion was statistically significant. Conclusion Factors including time to antibiotics, time to operative debridement, smoking status, and chronic disease comorbidities were not predictive of either infection or nonunion in open hand fractures. Fracture type as defined by a modified Gustilo–Anderson classification was the factor most strongly related to the development of infection or nonunion in these fractures.

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Al-Sadek, Tabet A., Desislav Niklev, and Ahmed Al-Sadek. "Treatment of Pediatric Open Supracondylar Humerus Fractures: Case Report." Open Access Macedonian Journal of Medical Sciences 4, no. 4 (November 15, 2016): 680–82. http://dx.doi.org/10.3889/oamjms.2016.133.

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BACKGROUND: Open supracondylar fractures of the humerus are rare in children, and the treatment strategy for these fractures is yet to be standardised.AIM: We present the case of a 7-year-old boy with open supracondylar humerus fracture that was managed with an external wrist fixator.CASE PRESENTATION: A 7-year-boy was brought to our department with pain in the right arm after a fall from a height about 3 hours before admission. On examination, the elbow was found to be markedly swollen with restriction of movement of the right arm. A 4-cm-wide wound was also observed on the flexural aspect of the elbow, indicating severe contamination of the fractured site. Neurological examination revealed restriction of hand movement and decreased sensations, which suggested the possibility of nerve injuries.CONCLUSION: A good clinical outcome was achieved in this case, without the development of any complications over a 6-month follow-up period.

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Sunbol, Khalid Mohammed, Salman Nawaf Alsulami, Abdullah Mahfouz AlSharif, Dhari Atallah Alshammari, Mohammed Fadhel Alshehri, Sajidah Hisham Abu Alsaud, Shaya Khoshiban Alkhoshiban, et al. "Causes, complications, and treatment of open ankle fracture." International Journal Of Community Medicine And Public Health 10, no. 1 (December 29, 2022): 474. http://dx.doi.org/10.18203/2394-6040.ijcmph20223577.

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Open ankle fractures are uncommon (3-6%) among all ankle fractures. Emerging trends show that the incidence of low-energy open ankle fractures is prevalent in older women. The mechanism of open fracture management continues to pose difficulties for orthopaedic surgeons. A simple fall is responsible for just under half of all fractures caused by motor vehicle collisions (MVCs). Despite technological advancements and surgical methods, infectious and non-infectious rates remain problematic. The mainstay of care is to combine antibiotic therapy with thorough irrigation and debridement. To prevent additional soft tissue and vascular damage, these fractures must be stabilized immediately, preferably with an external fixator. When the residual infection has cleared and the soft tissue envelope is adequate, do a definitive open reduction and internal fixation, adapting the procedure to the patient and type of fracture. Functional outcomes could be enhanced by taking safeguards against preventable comorbidities to reduce postoperative complications.

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Wiersema, Brent, David Brokaw, Timothy Weber, Telly Psaradellis, Carlo Panero, Chad Weber, and Dana Musapatika. "Complications Associated with Open Calcaneus Fractures." Foot & Ankle International 32, no. 11 (November 2011): 1052–57. http://dx.doi.org/10.3113/fai.2011.1052.

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Background: Literature on open calcaneus fractures is limited and inconsistent. This study's purpose was to report complications such as osteomyelitis, amputations, and soft tissue infections in open calcaneus fractures that were treated at a Level I Trauma Center. Methods: From January 1995 through December 2007, 1,157 calcaneus fractures were identified with 127 fractures being open (11.0%). Average followup time was 9.1 (range, 2 to 53) months. All open fractures were treated by a similar protocol of intravenous (IV) antibiotics, emergent irrigation and debridement (I&D), initial fracture stabilization if possible, subsequent I&Ds as needed, and delayed definitive fixation. One hundred fifteen open calcaneus fractures in 112 patients had sufficient followup for study inclusion. For this study complications were classified into four categories: superficial infections, deep infections, osteomyelitis, and amputations. Results: Medial based wounds occurred in 63 (54.8%) fractures. The overall complication rate was 23.5% with 16 fractures (13.9%) requiring a reoperation. Eleven (9.6%) fractures experienced superficial wound infection and 14 (12.2%) had deep wound infection. Six (5.2%) amputations were required with three being for either soft tissue infection or wound necrosis. Culture-positive osteomyelitis occurred in six (5.2%) patients. Conclusion: Utilizing a standardized protocol, open calcaneus fractures were found to have a lower complication rate than has been previously reported. Level of Evidence: III, Retrospective Comparative Study

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Johnson, A. L., J. P. Toombs, D. J. Schaeffer, and P. H. Laverty. "Simple and multiple fractures of the radius treated with an external fixator." Veterinary and Comparative Orthopaedics and Traumatology 15, no. 02 (2002): 97–103. http://dx.doi.org/10.1055/s-0038-1632721.

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SummaryThe medical records of 56 dogs with diaphyseal fractures of the radius and ulna treated with Type lb or Type II external skeletal fixation were reviewed. The patients were referred to the College of Veterinary Medicine University of Illinois or the Purdue University School of Veterinary Medicine during the period from 1983 to 1999. There were thirty-two “simple” fractures and twenty-four multiple fractures. Twenty-four Type II frames and eight Type lb frames were used to treat the “simple” fractures. Twenty Type II frames and four Type lb frames were used to treat the multiple fractures. Eight of the thirty-two dogs with “simple” fractures and twelve of the twenty-four dogs with multiple fractures were admitted with open fractures. Open fractures were associated with a significantly longer time to fracture “bridging” Open reduction was used more frequently for the treatment of dogs with “simple” fractures. Open reduction resulted in greater bone contact at the fracture site. Contact at the fracture site resulted in a shorter time to removal of the external fixation. Clinical union was achieved in fifty of fifty-six fractures, with a mean time to removal of the fixation of 14.2 weeks. Significant difference, in the mean time to fracture “bridging” or the mean time to fixator removal, were not found between the “simple” and multiple fracture groups. Complications occurred in 25% (14/56) of fractures. Complications of fracture healing occurred in 18% (9/56) of fracture repairs, and fracture related complications occurred in 9%. The complications occurred more frequently in dogs weighing under 5 kg. There was not any difference between the “simple” and multiple fracture groups, with respect to the type or frequency of complications experienced. The results of this study indicate that stabilization, with an External Fixator, is an appropriate treatment for both “simple” and multiple diaphyseal fractures of the radius and ulna.

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Raschke, Michael, Michael Højby Rasmussen, Shunmugam Govender, David Segal, Mette Suntum, and Jens Sandahl Christiansen. "Effects of growth hormone in patients with tibial fracture: a randomised, double-blind, placebo-controlled clinical trial." European Journal of Endocrinology 156, no. 3 (March 2007): 341–51. http://dx.doi.org/10.1530/eje-06-0598.

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Objective: Investigate whether intervention with GH after tibial fracture enhances fracture healing. Design: Randomised, double-blind, placebo-controlled study in 406 patients (93 women, 313 men, age: 18–64 years) with tibial fracture. Methods: Patients were stratified by tibial fracture (open or closed) and allocated to placebo or GH treatment (15, 30 or 60 μg/kg daily, until clinically assessed healing or until 16 weeks post-surgery). Primary outcome was time from surgery until fracture healing and assessment of healing was done centrally and observer blinded. Patients reported for evaluation every 4 weeks until 24 weeks, and at 9 and 12 months. Results: GH did not accelerate time to healing in the combined group of open and closed fractures. When separately analysing the closed and open fractures, a significant difference in time to healing was observed between treatment groups, exclusively in the closed fractures (P<0.05; subgroup analysis revealed that the 60 μg/kg group was significantly different from placebo). The relative risk of fracture healing for 60 μg/kg versus placebo during the 12 month was: all fractures, 1.16; 95% CI: (0.86; 1.57) (ns); closed fractures, 1.44; 95% CI: (1.01; 2.05; P<0.05); open fractures, 0.75; 95% CI: (0.42; 1.31) (ns). The estimated median number of days before fracture healing in closed fractures was 95 with 60 μg/kg versus 129 with placebo (95% CI: (94; 129) and (94; 249)) corresponding to approximately 26% decrease in healing time. Conclusions: In the overall group of open and closed tibial fractures, no significant enhancement of fracture healing was observed with GH, whereas in closed tibial fractures, GH accelerated healing significantly.

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KRISHNA, Sathya Vamsi, Akshay Bailahalli GIRISH, Jainath REDAPPA, and Chandrashekar HOSAHALLI. "Irreducible Phalangeal Fractures Due to Incarceration into the Extensor Tendon Apparatus – A Report of Two Patients." Journal of Hand Surgery (Asian-Pacific Volume) 27, no. 01 (February 2022): 209–12. http://dx.doi.org/10.1142/s2424835522720092.

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Irreducible phalangeal fractures are uncommon, and if neglected can cause fracture non-union or functional deficits of the affected digit. We present two patients with irreducible phalangeal fractures – one in a child with a juxta-epiphyseal middle phalanx fracture incarcerated into the triangular ligament of the extensor apparatus and another in an adult following incarceration of a fractured proximal phalanx into the common intrinsic tendon on the radial side. Both required open reduction to extricate the incarcerated fracture ends, achieving good union and excellent functional outcomes. Level of Evidence: Level V (Therapeutic)

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Malhotra, Ajai Kumar, Stephanie Goldberg, Jeffery Graham, Nancy R. Malhotra, Mark C. Willis, Varatharaj Mounasamy, Kelly Guilford, et al. "Open extremity fractures." Journal of Trauma and Acute Care Surgery 76, no. 5 (May 2014): 1201–7. http://dx.doi.org/10.1097/ta.0000000000000205.

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Jones, Alan L., James N. Powell, James F. Kellam, Robert G. McCormack, William Dust, and Patrick Wimmer. "OPEN PELVIC FRACTURES." Orthopedic Clinics of North America 28, no. 3 (July 1997): 345–50. http://dx.doi.org/10.1016/s0030-5898(05)70293-5.

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S. Newman, Andrew, and Stephen J. Kovach. "Open tibial fractures." Current Orthopaedic Practice 22, no. 1 (2011): 47–52. http://dx.doi.org/10.1097/bco.0b013e3182059297.

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Bennett, A. R., and K. D. Smith. "(ii) Open fractures." Orthopaedics and Trauma 27, no. 1 (February 2013): 9–14. http://dx.doi.org/10.1016/j.mporth.2013.01.001.

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Trionfo, Arianna, Priscilla K. Cavanaugh, and Martin J. Herman. "Pediatric Open Fractures." Orthopedic Clinics of North America 47, no. 3 (July 2016): 565–78. http://dx.doi.org/10.1016/j.ocl.2016.02.003.

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Duncan, Richard, Felix Savoie, and William B. Geissler. "OPEN FOREARM FRACTURES." Southern Medical Journal 83, Supplement (September 1990): 2S—50. http://dx.doi.org/10.1097/00007611-199009001-00195.

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JOHNSON, ERIC E., and LANCE B. DAVLIN. "Open Ankle Fractures." Clinical Orthopaedics and Related Research 292 (July 1993): 118–27. http://dx.doi.org/10.1097/00003086-199307000-00014.

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35

Bircher, Martin. "Open Pelvic Fractures." European Journal of Trauma 31, no. 6 (November 2005): 526–35. http://dx.doi.org/10.1007/s00068-005-2111-z.

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Fernandez, Miguel A., Jagdeep Nanchahal, and Matthew L. Costa. "Open tibial fractures." Orthopaedics and Trauma 31, no. 2 (April 2017): 125–32. http://dx.doi.org/10.1016/j.mporth.2016.10.002.

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Kassam, Al-Amin M., Scott A. Adams, and Mark R. Williams. "Open pelvic fractures." Orthopaedics and Trauma 32, no. 2 (April 2018): 91–94. http://dx.doi.org/10.1016/j.mporth.2018.01.006.

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J Lawrence, Steven. "Open Calcaneal Fractures." Orthopedics 27, no. 7 (July 1, 2004): 737–41. http://dx.doi.org/10.3928/0147-7447-20040701-14.

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Hanson, Peter B., Joseph C. Milne, and Michael W. Chapman. "Open Pelvis Fractures." Journal of Orthopaedic Trauma 4, no. 2 (June 1990): 220. http://dx.doi.org/10.1097/00005131-199004020-00046.

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Aldridge,, Julian M., Mark Easley, and James A. Nunley. "Open Calcaneal Fractures." Journal of Orthopaedic Trauma 18, no. 1 (January 2004): 7–11. http://dx.doi.org/10.1097/00005131-200401000-00002.

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41

Hargreaves, D. G., and M. S. Davies. "Open tibial fractures." British Journal of Plastic Surgery 46, no. 4 (1993): 344–45. http://dx.doi.org/10.1016/0007-1226(93)90024-6.

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42

Govender, S., A. Sham, and B. Singh. "Open pelvic fractures." Injury 21, no. 6 (November 1990): 373–76. http://dx.doi.org/10.1016/0020-1383(90)90122-b.

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Li, Jianxiong, Shiming Dong, Wen Hua, Xiaolong Li, and Xin Pan. "Numerical Investigation of Hydraulic Fracture Propagation Based on Cohesive Zone Model in Naturally Fractured Formations." Processes 7, no. 1 (January 8, 2019): 28. http://dx.doi.org/10.3390/pr7010028.

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Complex propagation patterns of hydraulic fractures often play important roles in naturally fractured formations due to complex mechanisms. Therefore, understanding propagation patterns and the geometry of fractures is essential for hydraulic fracturing design. In this work, a seepage–stress–damage coupled model based on the finite pore pressure cohesive zone (PPCZ) method was developed to investigate hydraulic fracture propagation behavior in a naturally fractured reservoir. Compared with the traditional finite element method, the coupled model with global insertion cohesive elements realizes arbitrary propagation of fluid-driven fractures. Numerical simulations of multiple-cluster hydraulic fracturing were carried out to investigate the sensitivities of a multitude of parameters. The results reveal that stress interference from multiple-clusters is responsible for serious suppression and diversion of the fracture network. A lower stress difference benefits the fracture network and helps open natural fractures. By comparing the mechanism of fluid injection, the maximal fracture network can be achieved with various injection rates and viscosities at different fracturing stages. Cluster parameters, including the number of clusters and their spacing, were optimal, satisfying the requirement of creating a large fracture network. These results offer new insights into the propagation pattern of fluid driven fractures and should act as a guide for multiple-cluster hydraulic fracturing, which can help increase the hydraulic fracture volume in naturally fractured reservoirs.

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Lai, Chih-Yang, Po-Ju Lai, I.-Chuan Tseng, Chun-Yi Su, Yung-Heng Hsu, Ying-Chao Chou, and Yi-Hsun Yu. "Postoperative Reduction Quality May Be the Most Important Factor That Causes Worse Functional Outcomes in Open and Closed Pelvic Fractures." World Journal of Surgery 46, no. 3 (January 1, 2022): 568–76. http://dx.doi.org/10.1007/s00268-021-06386-9.

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Abstract Background Data on the functional outcomes of patients with open pelvic fractures after osteosynthesis are limited, and whether open fracture is a risk factor for worse outcomes, as compared with closed fracture, remains unclear. This study aimed to compare the functional outcomes of patients with open and closed pelvic fractures and evaluate potential factors that might affect outcomes. Methods Overall, 19 consecutive patients with open pelvic fractures and 78 patients with closed pelvic fractures between January 2014 and June 2018 were retrospectively reviewed. All fractures were surgically treated, with a minimal follow-up period of three years. Patients’ demographic profile, associated injuries, management protocol, quality of reduction, and outcomes were recorded and analyzed. Results Patients with open pelvic fractures had higher new injury severity score, higher incidence of diverting colostomy, and longer length of stay. Both radiological and functional evaluations revealed no significant differences between the two groups at 1-year and 3-year evaluations. Multiple logistic regression analysis identified poor radiological outcomes (using Lefaivre criteria) and longer length of stay as risk factors for worse short-term functional outcomes. At 3-year evaluation, fair-to-poor radiological outcomes (using Matta/Tornetta and Lefaivre criteria) and the presence of diverting colostomy were potential risk factors. Conclusions Compared with closed pelvic fracture, open pelvic fracture was not an indicator of worse functional outcomes. Functional outcomes may be comparable between patients with open and closed pelvic fractures at different time points within three years postoperatively. Achieving anatomical reduction in a fracture is crucial, because it might affect patient satisfaction.

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Толстых and A. Tolstykh. "Open reposition of fresh shoulder dislocations fractures." Journal of New Medical Technologies. eJournal 8, no. 1 (November 5, 2014): 1–4. http://dx.doi.org/10.12737/4788.

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The closed reposition of fresh dislocations fractures of the shoulder, when the line of the fracture runs on anatomical and surgical neck shoulder is the most complicated problem for orthopedic surgeons. In practical author’s activity in the last five years, 11 patients with fresh dislocations fractures were operated; in these cases, the line of the fracture passed on anatomical and surgical neck shoulder. The proposed technique is non-invasive reposition and fixation of dislocations fractures. Features of this method are the access with truncation of the coracoid process; partial cutting tendons subscapularis muscle; the reduction of the head arm by means of elevator, pricker or threaded wires at the end. The screws were conducted directly through the line of fracture for reliable tightening of fragments. The author’s technique has no flaws in widely used at present approaches for similar pathologies, namely: there is no extensive exposure of bone fragments, devascularization bones. This minimally invasive surgery is a quick (2-2,5 months) in comparison with traditional (3-3,5 months) consolidation of fragments. The author notes, almost full recovery of volume of movement in a joint, as a consequence of social and labor rehabilitation of patients, compared with a high probability of shoulder surgery that is according to the literature the most likely outcome of such operations.

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Krasnov, S. A., V. E. Dubrov, and B. N. Kolesnikov. "Extrafocal osteosynthesis in open crus fractures." N.N. Priorov Journal of Traumatology and Orthopedics 4, no. 2 (June 15, 1997): 30–33. http://dx.doi.org/10.17816/vto106699.

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The purpose of this study was to compare the treatment of open crus fractures with pin (116 patients) versus rod (107 patients) extrafocal fixation devices. In all cases primary osteosynthesis was performed within the first hours after trauma. Authors consider that choice of extrafocal fixation technique depends on the pattern of open fracture. Rod fixation is preferred in simple or wedge fractures. Pin fixation provides better outcome in all types of comminuted shaft fractures. Rod fixators are of more simple design than pin ones and it takes less time to handle with them. Uncomplicated postoperative period was noted in 179 patients (80.3%) out of 223. Purulent complications were in 16.5% of cases (5.8% of cases in rod fixation, 10.7% of cases in pin fixation). The rate of other complications was 3.2%.

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Arai, Daishi, Akihiro Yasue, Shinya Horiuchi, and Eiji Tanaka. "A Multidisciplinary Approach to Malocclusion Caused by Facial Multiple Fracture." Case Reports in Dentistry 2022 (March 3, 2022): 1–8. http://dx.doi.org/10.1155/2022/5209667.

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In the case of multiple facial fractures, a simple open reduction occasionally causes various disorders during healing process after the surgery. Moreover, esthetic disturbance of a facial deformity might be induced. Therefore, the acquisition of facial symmetry and the recovery of occlusal and masticatory functions become increasingly important. This case report presents a successful treatment of facial multiple fracture induced by a car accident. A 20-year-old male was diagnosed with suffered multiple midface and mandibular fractures induced by a car accident. Midface fractures included the LeFort I and II type fractures, as well as sagittal fracture at midline and fractures from right maxillary sinus anterior wall to orbital wall. In the mandible, midline and left body fractures were detected. The patient underwent open reduction and rigid fixation of the fractured left zygoma, comminuted LeFort I and II fractures, and midline and left body of the mandible with intermaxillary fixation by multibracket appliance; maxillary osteotomy with iliac bone grafting; orthognathic two-jaw surgery with coronoid process grafts onto the depressed zygoma; and onlay graft of hydroxyapatite block on mandible. As the result, the multidisciplinary treatments successfully recover functions and esthetics to the satisfactory level of the patient with multiple facial fractures. As treatments for multiple facial fractures are required complexity due to the extent of trauma, multidisciplinary approach under the close cooperation between hospital departments is thought to be important.

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Alawad, Mohammad O., Saleh Alharthi, Jameel Mahmoud, Basam Alanazi, and Saad Surur. "Open Fracture of the Acromion: An Isolated Injury with Oblique-Type Fracture." Case Reports in Orthopedics 2018 (June 10, 2018): 1–3. http://dx.doi.org/10.1155/2018/2107059.

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Open acromial fractures are a rare set of fractures. We report a case of Gustilo IIIA open acromial fracture (14A2 as per OTA scapular fracture classification) that was isolated from any other injury. Our patient had a good recovery and showed excellent clinical outcome after irrigation and screw fixation of the acromial fracture. We also reviewed the literature for other cases of open acromial fracture.

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Hayashi, Kamichika, Takeshi Onda, Hirona Honda, Mitsuru Takata, Hiroyuki Matsuda, Hidetoshi Tamura, and Masayuki Takano. "High Submandibular Anteroparotid Approach for Open Reduction and Internal Fixation of Condylar Fracture." Case Reports in Dentistry 2021 (July 9, 2021): 1–9. http://dx.doi.org/10.1155/2021/5542570.

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Aim. There are several techniques for the treatment of mandibular condylar fractures. This is the first report of the high submandibular anteroparotid approach for open reduction and internal fixation of condylar fracture. Materials and Methods. A 41-year-old woman fell indoors and injured her face. She was referred to our department for detailed examination and treatment of a suspected mandibular fracture. X-ray and computed tomography showed a right mandibular condylar base fracture and lateral dislocation of the fracture fragment. Open reduction and internal fixation procedures were performed for a right mandibular condylar fracture under general anesthesia. The mandibular ramus was reached by approaching from the inferior margin of the mandible, delaminating the masseter fascia posteriorly, and bypassing the anterior margin of the parotid gland. Once the fractured bone was reached, reduction and fixation were performed. Results. We have achieved good results by the high submandibular anteroparotid approach, which is minimally invasive and simple, to reduce and fix condylar fractures. With this approach, no facial artery or retromandibular vein was encountered, and the mental stress for the surgeon was minimal. Postoperative wound infection, parotid gland complications such as parotitis and salivary fistula, facial nerve dysfunction such as facial paralysis, and esthetic disorders such as scarring were not observed. Conclusions. Although it is necessary to examine more cases in the future, the high submandibular anteroparotid approach may be useful as a new approach for open reduction and internal fixation of condylar fractures.

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Cerrina Feroni, A., and P. Martinelli. "The relationship between the open fractures and mineralized fractures in Oligocene sandstones of Leghorn coast (Tuscany, Italy) – the hydrogeological relapses." Hydrology and Earth System Sciences Discussions 7, no. 2 (April 12, 2010): 2301–16. http://dx.doi.org/10.5194/hessd-7-2301-2010.

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Abstract. The Oligocene-Miocene turbidite sandstones of fore-deep in the Northern Apennines form a very great aquifer that originally, before the reduction by Plio-Pleistocene erosion, is extended over an area of 60 000 sq/km (minimum) to 1.5 km–4.5 km tickness. The spatial relationships between the open fractures and mineralized fracture (veins) in the outcrops of foredeep's sandstones (Macigno) along the Tuscany coast, between Leghorn and Piombino (Northern Apennines), are analyzed and discussed. Also is discussed a conceptual model that allows a virtual surface of separation between an upper zone in open fractures and a fracture in the lower zone mineralization. The position of this surface than the topography surface, depends on the difference between the velocity of erosion and the velocity development of open fractures by reduction of the lithostatic load, during the exhumation of the system. The lack of the open fractured zone, below this surface suggests that the deep water circulation into the Macigno sandstones along the coast area, depends exclusively on the connection between the major faults and the primary discontinuity (stratification). Based on the results of fracturing analysis of the coastal Macigno the authors aim to extend the research to internal areas, and in particular to the ridge of the Northern Apennines, where the foredeep's sandstones are well developed and continued.

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Journal articles on the topic 'Fractures, Open'

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